renal, penile and testicular cancer Flashcards
renal tumours
- renal cell carcinoma
- oncocytoma
- angiomyolipoma
benign renal tumours
renal cysts, oncocytoma, angiomyolipoma, adenoma and fibroma
malignant renal tumours
renal cell carcinoma
embryonic renal tumour
nephrobalstoma (otherwise known as wilms tumour)
most common presentation of renal tumours
found incidentally on ultrasound
benign renal cysts
extremely common and the vast majority are benign, the increased the complexity of the cyst the more likely it is to be malignant
angiomyolipoma
benign tumour which contains blood vessels, fat and muscle
although angiomyolipoma is benign there is a risk of
haemorrhage
angiomyolipomas are diagnosed using
CT to measure the density of the lesion which is reported in hounsefield units
how many hounsefiedl units is diagnostic of an angiomyolipomas
greater than 10
angiomyolipomas between 4-6cm
have a risk of spontaneous haemorrhage which can caused wunderlichs syndrome which is massive retro-peritoneal bleeding which can be fata therefore lesions of this size are embolized
oncocytoma
benign renla tumour however, it cannot be differentiated from a renal cell carcinoma until after nephrectomy
on ct of an oncocytoma
there is a central scar
renal cell carcinoma classic triad
- renal mass
- frank haematuria
- loin pain
frank haematuria is
urothelial carcinoma until proven otherwise however, after you have ruled it out part to rule out things like renal cell carcinoma
renal cell carcinoma is a common cause of
paraneoplastic sydnromes
renal cell carcinomas
arise from the epithelial cells of the proximal convoluted tubule
renal cell carcinoma most common type
clear cell
multi-focal or bilateral renal cell carcinoma should shout out
VON HIPPEL LINDAU SYDNROME
Diagnosis of renal cell carcinoma
triple phase contrast CT which shows enhancement
why is biopsy not carried out for renal cell carcinomas
because it doesn’t let you differentiate between a renal cell carcinoma and an oncocytoma
Do renal cell carcinomas commonly extend outside the renal capsule
no they commonly spread into the renal veins and to the inferior vena cava where they metastasise to the lungs and bones
treatment of renal cell carcinoma
gold standard is a radical nephrectomy where the whole kidney is removed as well as gerotas fascia but the adrenal gland is left in place unless it is involved
renal cell carcinomas are not responsive to what
radiotherapy
management of metastatic disease in renal cell carcinoma
surgery is still carried out where possible and tyrosine kinase inhibitors such as sunitinib
pre-malingnat cutaneous penile conditions
- balanitis xerotica obliterates and leukoplakia
spumous cell carcinoma of the penis is either
squamous cell carcinoma in situ or invasive squamous cell carcinoma
balanitis xerotica obliterans is also known as
lichens sclerosis et atrophicus
balnaitis xerotic obliterates usually present with
tight foreskin which cannot be retracted with a white demarcated line, causes fissuring and bleeding
management of balanitis xerotica obliterates
circumcission
balanitis xerotica obltierans has
a very low risk of becoming malignant and circumcission reduces this risk
squamous cell carcinoma in situ presentation
red velvety patches on the pic or under the foreskin which do not go away
squamous cell carcinoma in situ should be differentiated from
zoons ballonitis which only causes redness
sqauous cell carcinoma in situ affecting the gland, prepuce or shaft is known as
erythropalsia of query
anywhere else on the penis is known as
bowens disease
treatment of squamous cell carcinoma in situ
if only the prepuce is involved circumcission but if any other part of the penis is involved topical- 5-fluoracil-
invasive squamous cell carcinoma of the penis is often
a delayed presentation and present with a foul smell and phimosis
diagnosis of invasive spumous cell carcinoma of the penis
ultrasound and MRI
lymphadenopathy in invasive squamous cell carcinoma of the penis is
inguinal as the penis drains to the superficial inguinal nodes
treatment of penis squamous cell carcinoma
partial or total penectomy and sentinel node biopsy
testicular tumours
germ cell tumours:
- seminoma
- non-seminomatous germ cell tumours= teratomas, embryonal yolk sac and choriocarcinoma(all stem cell tumours)
- intra-tubule germ cell neoplasms
presentation of testicualr tumours
painless tessticualr swelling which is stony hard
do testicualr tumours metastasise
yes 10% of people present with metastasis with supra-clavicular metastasis common
diagnosis of testicualr tumours
ultrasound
what else does a testiualr tumour require before carrying out surgery
chest x-ray to look for cannonball metastases
tumour markers measures before surgery
- alpha foeto protein (AFP)= IS never elevated in a seminoma
- beta-HCG= elevated in 10% seminomas and 60% of teratomas and is ALWAYS ELEVATED IN TROPHOBLAST TUMOURS
- LDH= used to measure tumour burden
treatment of testicualr tumour
orchidectomy through inguinal access and high ligation of the cord with insertion of a prosthetic testicle
what is measured after orchidectomy
tumour markers
where do the testis drain lympahticallt
to the para-aortic lymph nodes therefore, you cannot palpate lymph nodes in testicualr tumours
