Renal, Penile and testicular cancer

Question 1

What is the typical presentation of renal cell carcinomas ?

Answer 1

• Loin pain
• Renal mass
• Haematuria
• Malignancy signs - Weight loss, anaemia, hypercalcaemia

Question 2

How are renal cell carcinomas diagnosed ?

Answer 2

• USS - good initial test
• CT - this is diagnostic

Question 3

What is the treatment of renal cell carcinomas ?

Answer 3

1st line = Radical Nephrectomy

Metastatic:

• IL2
• Interferon alpha
• Sunitinib

Question 4

What is the premalignant lesion affecting the penis ?

Answer 4

Balanitis xerotica obliterans (linchen sclerosus)

Question 5

Describe the presentation of Balanitis xerotica obliterans (linchen sclerosus)

Answer 5

Causes white patches, fissuring, bleeding. scarring

Question 6

What is the main type of cancer affecting the penis ?

Answer 6

Squamous cell carcinoma

Question 7

What is meant by a carcinoma in situ ?

Answer 7

Means that the cells of these cancers are still only in the epidermis (the upper layer of the skin) and have not invaded into deeper layers.

Question 8

What are the 2 classes of carcinoma in situ which affect the penis ?

Answer 8

• Erythroplasia of Queyrat
• Bowens disease

Question 9

How do Erythroplasia of Queyrat and bowens disease present on the penis ?

Answer 9

Red velvety patches

Question 10

When is a squamous cell carcinoma in situ on the penis classified as bowens disease and when is it classified as Erythroplasia of Queyrat?

Answer 10

Erythroplasia of Queyrat = on the Glans, prepuce or shaft of penis

Bowens disease = Remainder of genitalia

Question 11

What is the treatment for squamous cell carcinomas in situ (bowens or erythroplasia of queryat) of the penis ?

Answer 11

• If prepuce alone - circumcision
• If not - Topical 5 fluorouracil

Question 12

How do squamous cell carcinomas of the penis typically present ?

Answer 12

• Red raised area penis
• Fungating mass, foul smelling
• Phimosis

Question 13

How is a squamous cell carcinoma of the penis diagnosed ?

Answer 13

• Physical exam
• Cytology or histological diagnosis

Question 14

What are the risk factors for developing a squamous cell carcinoma of the penis ?

Answer 14

• Peak incidence 80 yrs of age
• HPV (16)

Question 15

Where do tumours of the penis most commonly affect ?

Answer 15

The glans or prepuce

Question 16

What is the treatment for carcinomas of the penis ?

Answer 16

• Total/ partial penectomy
• Sentinel Biopsy
• Inguinal lymphadenectomy

Question 17

What are the main types of tumours affecting the testicles and what cells do they arise from ?

Answer 17

• Seminomas and teratomas
• Arise from germ cells

Question 18

How do testicular tumours often present ?

Answer 18

Painless, insensitive testicular swelling

Question 19

How are testicular tumours diagnosed ?

Answer 19

• US
• and tumour markers (covered in pathology lecture)

Question 20

What is the main risk factor for testicular tumours ?

Answer 20

Undescended testis - increases the risk x 30

Question 21

What are the different classes of teratomas ?

Answer 21

• Differentiated
• Intermediate
• Undifferentiated
• Trophoblastic

Question 22

What lymph nodes do testicular tumours tend to metastaise to ?

Answer 22

Para-aortic lymph nodes

Question 23

What is the treatment of testicular tumours ?

Answer 23

• For seminoma - use radiotherapy
• For teratoma - use chemotherapy

Then should do orchidectomy (remove testicle)