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Renal > Renal, penile and testicular cancer > Flashcards

Renal, penile and testicular cancer Flashcards

1
Q

How does an RCC spread/grow?

A

Grows into vena cava and can therefore metastasise to lungs

Can also spread to lymhatics

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2
Q

Sites of metastasis for RCC?

A

Lungs
Liver
Bone
Brain

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3
Q

RCC diagnosis?

A 
USS
CT
Triple phase contrast
Biopsy
High false negative in RCC
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4
Q

What is an RCC? (histologically)

A

Adenocarcinoma of PCT

Clear cell, papillary

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5
Q

Adenocarcinoma of PCT

Clear cell, papillary

A

RCC

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6
Q

Von Hippel-lindau

A

Von Hippel-Lindau: an inherited disorder causing multiple tumours, both benign and malignant. Most common tumours are retinal and CNS hemangioblastomas. RCC, renal cysts and phaeochromocytoma

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7
Q

Classical triad of RCC?

A

Loin pain
Renal mass
Haematuria

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8
Q

Paraneoplastic syndrome associated with RCC?

A

Weight loss
Hypercalcemia
Anaemia
HT

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9
Q

Pre-malignant cutaneous lesions of penile cancer?

A

Balantitis xerotica obliterans, leukoplakia

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10
Q

Red raised area penis
Fungating mass
Foul smelling
Phimosis

A

Carcinoma of penis

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11
Q

HPV associated with penile carcinoma?

A

HPV16

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12
Q

Lymph nodes you should remove in penis cancer

A

Inguinal nodes

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13
Q

RCC adjuvant therapy?

A 
IL2
Interferon alpha
Tyrosine kinase inhibitors
VEGF/PDGF inhibitors
-reduce neovascularisation
-26 months vs 20 months prognosis --> VERY GOOD
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14
Q

L2
Interferon alpha
Tyrosine kinase inhibitors
VEGF/PDGF inhibitors

A

Adjuvant therapy for RCC

  • reduce neovascularisation
  • 26 months vs 20 months prognosis –> VERY GOOD
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15
Q

Chemical marker present in:
5-10% pure seminoma
Up to 60% teratoma

A

HCG

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16
Q

Chemical marker never raised in pure seminoma?

A

AFP

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17
Q

Chemical marker used to assess tumour burden?

A

LDH

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18
Q

Biggest risk factor for germ cell testicular tumours?

A

Undescended testes

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19
Q

Peak age incidence for testiculour tumours?

A

20-35 years

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20
Q

Marker for trophoblastic teratomas?

A

100% have elevated HCG

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21
Q

Robotis laparoscopy

A

Partial nephrectomy

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22
Q

Removal of whole kidney within Gerota’s fascia

Perinephric fate

A

Radical nephrectomy

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23
Q

ECOG performance status

A

Shows how

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24
Q

Balantitis xerotica obliteran

Leukoplakia

A

Pre-malignant cutaneous lesions of penile cancer

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25
Q

Lichenus slerosus et atrophicus

A

Balantitis xerotica obliterans

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26
Q

Where does Erythroplasia of Queryat affect?

A

Glans, prepuce or shaft of penis

Bowen’s disease is the remainder of genitalia

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27
Q

Red raised area on penis
Fungating mass, foul smelling
Phimosis

A

Carinoma of penis presentation

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28
Q

HPV associated with penis cancer

A

HPV 16

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29
Q

Most common pre-pubertal germ cell testicular tumour

A

Yolk sac tumour

30
Q

When is AFP never raised?

A

Seminoma

31
Q

When is HCG raised?

A

5-10% pure seminoma

Up to 60% teratoma

32
Q

What does LDH show?

A

Tumour burden

33
Q

Inguinal vs scrotum approach?

A

Inguinal because recurrence is lower than scrotum

34
Q

Which type of teratoma is 100% associated with HCG?

A

Trophoblastic

35
Q

Conditions associated with a raised PSA?

A
  • Prostate cancer
  • Benign prostatic hyperplasia
  • Prostatitis/UTI’s
  • Retention
  • Catheterisation
  • DRE
36
Q

Down sides of TRUS biopsy? (trans-rectal ultrasound guided biopsy)

A
  • uncomfortable
  • 1 risk of significant sepsis and bleeding
  • may need repeat biopsy
37
Q

Indications for TRUS?

A
  • Men with abnormal DRE, an elevated PSA
  • Previous biopsies showing PIN or ASAP (basically weird cells)
  • Previous normal biopsies but rising PSA trends
38
Q

How many biopsies taken from the prostate?

A

10 biopsies taken (5 from each lobe)

39
Q

Complications of TRUS?

A

Sepsis
Rectal bleeding
Vaso-vagal fainting
Haematospermia and haematuria for 2-3 weeks after the procedure

40
Q

Most common sites for prostatic cancer metastasis?

A

Pelvic lymph nodes and the skeleton

41
Q

Sclerotic lesions are characteristic of what?

A

Prostatic cancer

42
Q

What is the Gleason scoring system based on when grading prostate cancer?

A

It is based on architectural appearance of the prostate glands rather than cytological features

43
Q

Initial histological feature of prostate cancer?

A

Loss of basement membrane

44
Q

The gleason score increases with what?

A

Increases with loss of the glandular structure and replacement by a disorganised malignant cell growth pattern

  • The two most abundant cell patterns are assessed and then added together to give a score between 2 to 10
  • Gleason’s score is a very good predictor of prognosis and is therefore widely used
45
Q

Transitional zone surrounds what

A

The urethra- gives rise to BPH

46
Q

Which area gives rise to BPH?

A

The transitional zone

47
Q

The central zone surrounds what?

A

The ejaculatory duct

48
Q

Prostate cancer symptoms

A

Lower UTI symptoms
Haematuria/haematospermia
Bone pain, anorexia, weight loss

49
Q

Are most prostate cancers unifocal or multifocal?

A

Multi focal

50
Q

What is the initial feature of malignancy?

A

Loss of basement membrane

51
Q

How does Gleason scoring work?

A

It is based on architectural appearance (not cytological features)

  • graded from 1-5
  • the 2 most abundant cell patterns are assessedd and added together to give a score between 2 and 10
52
Q

T1

A

Clinically inapparent tumour not palpable or visible by imaging

53
Q

T2

A

tumour confined within prostate

54
Q

T3

A

Tumour extends through prostatic capsule

55
Q

T4

A

Tumour fixed or invades adjacent structures other than seminal vesicles; bladder neck, external sphincter, rectum, levator muscles or pelvic wall

56
Q

Imaging modalities for staging

A

Bone scan
MRI
CT scan

57
Q

Organ confined disease

A

T1-2 N0 M0

58
Q

Locally advanced disease

A

T3-4 N0 M0

59
Q

Metastatic disease

A

N+ M+

60
Q

Complications of radical surgery

A

Erectile dysfunction, incontinence, bladder neck stenosis

61
Q

Complications of radical radiotherapy?

A 
Irritative LUTS
Haematuria
GI symtpoms
Erectile dysfunction
Incontinence
62
Q

Treatment for metastatic disease

A

Androgen deprivation therapy (Hormonal therapy: LHRH analogues, Anti-androgens)

63
Q

Why do you give LHRH agonists in prostate cancer?

A

-eventually result in down regulation of LHRH receptors etc etc leads to decrease in testosterone - prostate not going to get any bigger/cell apoptosis :)

64
Q

Side effects of LHRH agonists?

A 
Loss of libido
Hot flushes and sweats
Weight gain
Gynaecomastia
Anaemia
Cognitive changes
Osteoporosis
65
Q

How do anti-androgens work?

A

Compete with testosterone for binding sites

  • promote apoptosis
  • inhibit CaP growth
66
Q

Steroid anti-androgen

A 
Cyproterone acetate
(loss of libido, ED, gynaecomastia, cardiovascular toxicity, hepatotoxicity)
67
Q

Non-steroidal anti-androgens

A

Nilutamide, flutamide, bicalutamide
SEXUAL INTEREST AND LIBIDO MAINTAINED
S/e gynaecomastia, breast pain and hot flashes hepatotoxicity

68
Q

Cyprterone acetat

A

Steroidal anti-androgen

69
Q

Nilutamide, flutamide and bicalutamide

A

Non-steroidal anti-androgens

70
Q

Two types of transitional cell cancer

A

1) papillary
2) non papillary

A well differentiated papilloma is considered grade 1 papilloma

71
Q

Urinary bladder HALO sign

A

Transitional cell carcinoma of bladder

72
Q

Calcified bladder, which type of cancer?

A

Squamous

Renal (44 decks)

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