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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
Lichenus slerosus et atrophicus
Balantitis xerotica obliterans
26
Where does Erythroplasia of Queryat affect?
Glans, prepuce or shaft of penis | Bowen's disease is the remainder of genitalia
27
Red raised area on penis Fungating mass, foul smelling Phimosis
Carinoma of penis presentation
28
HPV associated with penis cancer
HPV 16
29
Most common pre-pubertal germ cell testicular tumour
Yolk sac tumour
30
When is AFP never raised?
Seminoma
31
When is HCG raised?
5-10% pure seminoma | Up to 60% teratoma
32
What does LDH show?
Tumour burden
33
Inguinal vs scrotum approach?
Inguinal because recurrence is lower than scrotum
34
Which type of teratoma is 100% associated with HCG?
Trophoblastic
35
Conditions associated with a raised PSA?
- Prostate cancer - Benign prostatic hyperplasia - Prostatitis/UTI's - Retention - Catheterisation - DRE
36
Down sides of TRUS biopsy? (trans-rectal ultrasound guided biopsy)
- uncomfortable - 1 risk of significant sepsis and bleeding - may need repeat biopsy
37
Indications for TRUS?
- Men with abnormal DRE, an elevated PSA - Previous biopsies showing PIN or ASAP (basically weird cells) - Previous normal biopsies but rising PSA trends
38
How many biopsies taken from the prostate?
10 biopsies taken (5 from each lobe)
39
Complications of TRUS?
Sepsis Rectal bleeding Vaso-vagal fainting Haematospermia and haematuria for 2-3 weeks after the procedure
40
Most common sites for prostatic cancer metastasis?
Pelvic lymph nodes and the skeleton
41
Sclerotic lesions are characteristic of what?
Prostatic cancer
42
What is the Gleason scoring system based on when grading prostate cancer?
It is based on architectural appearance of the prostate glands rather than cytological features
43
Initial histological feature of prostate cancer?
Loss of basement membrane
44
The gleason score increases with what?
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
Transitional zone surrounds what
The urethra- gives rise to BPH
46
Which area gives rise to BPH?
The transitional zone
47
The central zone surrounds what?
The ejaculatory duct
48
Prostate cancer symptoms
Lower UTI symptoms Haematuria/haematospermia Bone pain, anorexia, weight loss
49
Are most prostate cancers unifocal or multifocal?
Multi focal
50
What is the initial feature of malignancy?
Loss of basement membrane
51
How does Gleason scoring work?
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
T1
Clinically inapparent tumour not palpable or visible by imaging
53
T2
tumour confined within prostate
54
T3
Tumour extends through prostatic capsule
55
T4
Tumour fixed or invades adjacent structures other than seminal vesicles; bladder neck, external sphincter, rectum, levator muscles or pelvic wall
56
Imaging modalities for staging
Bone scan MRI CT scan
57
Organ confined disease
T1-2 N0 M0
58
Locally advanced disease
T3-4 N0 M0
59
Metastatic disease
N+ M+
60
Complications of radical surgery
Erectile dysfunction, incontinence, bladder neck stenosis
61
Complications of radical radiotherapy?
``` Irritative LUTS Haematuria GI symtpoms Erectile dysfunction Incontinence ```
62
Treatment for metastatic disease
Androgen deprivation therapy (Hormonal therapy: LHRH analogues, Anti-androgens)
63
Why do you give LHRH agonists in prostate cancer?
-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
Side effects of LHRH agonists?
``` Loss of libido Hot flushes and sweats Weight gain Gynaecomastia Anaemia Cognitive changes Osteoporosis ```
65
How do anti-androgens work?
Compete with testosterone for binding sites - promote apoptosis - inhibit CaP growth
66
Steroid anti-androgen
``` Cyproterone acetate (loss of libido, ED, gynaecomastia, cardiovascular toxicity, hepatotoxicity) ```
67
Non-steroidal anti-androgens
Nilutamide, flutamide, bicalutamide SEXUAL INTEREST AND LIBIDO MAINTAINED S/e gynaecomastia, breast pain and hot flashes hepatotoxicity
68
Cyprterone acetat
Steroidal anti-androgen
69
Nilutamide, flutamide and bicalutamide
Non-steroidal anti-androgens
70
Two types of transitional cell cancer
1) papillary 2) non papillary A well differentiated papilloma is considered grade 1 papilloma
71
Urinary bladder HALO sign
Transitional cell carcinoma of bladder
72
Calcified bladder, which type of cancer?
Squamous

Renal (44 decks)

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