Renal system malignancies

Question 1

Area ejaculatory ducts drain into

Answer 1

Verumontanum

Question 2

Transitional zone of prostate

Answer 2

Surrounds prostatic urethra

Gives rise to BPH

Question 3

Peripheral zones of prostate

Answer 3

Posterolateral

Most prostate cancers

Question 4

Central zone

Answer 4

Surrounds ejaculatory ducts

Question 5

Most common malignancy affecting men in the UK

Answer 5

Prostate cancer

Question 6

Most common in who?

Answer 6

70-74 years
Western world
Black
FH

Question 7

Presentation of prostate cancer

Answer 7

Usually asymptomatic - picked up by PSA
Haematuria, haematospermia
Bone pain, anorexia, weight loss

Question 8

What is PSA?

Answer 8

Glycoprotein produced by epithelial cells of prostate

Question 9

Serum and semen levels of PSA

Answer 9

In health: semen levels high, serum levels low

In cancer: serum levels high

Question 10

Other conditions which elevate PSA?

Answer 10

BPH
Prostatitis/UTI
Retention
Catheter
PR exam

Question 11

Investigations for prostate cancer

Answer 11

PR exam
PSA
Transrectal US and biopsy
Bone scam, MRI, CT for staging

Question 12

What type are most prostate cancers?

Answer 12

Multifocal adenocarcinomas

Question 13

Most common prostatic mets

Answer 13

Spine - sclerotic

Pelvic nodes

Question 14

What scoring system used for prostate cancer grading?

Answer 14

Gleason’s score - based on appearance

Question 15

Appearance of prostate cancer

Answer 15

Loss of basement membrane then loss of glandular structure

Question 16

Treatment of prostate cancer

Answer 16

Watchful waiting
Surgery
Chemotherapy
Radiotherapy
Hormonal therapy

Question 17

Hormonal control of prostate

Answer 17

Under influence of testosterone

Deprived of testosterone = apoptosis

Question 18

Types of hormonal therapy

Answer 18

LHRH agonists

Anti-androgens

Question 19

How do LHRH agonists work?

Answer 19

Chronic exposure results in downregulation of LHRH receptors = suppression of LH and FSH and suppression of testosteron
Provide anti-androgen for 3 weeks due to initial increase

Question 20

Side effects of LHRH agonists

Answer 20

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

Question 21

How do anti-androgens work?

Answer 21

Compete with testosterone for receptors = apoptosis of cancer cells

Question 22

Side effects of anti-androgens

Answer 22

Steroidal: loss of libido, ED, gynaecomastia, hepatotoxic, cardiotoxic
Non-steroidal: gynaecomastia, hot flashes, hepatotoxic

Question 23

Diagnosis of bladder cancer

Answer 23

Xray
Uroscopy
CT

Question 24

Types of bladder cancer

Answer 24

Transitional cell 90%

SCC 9%

Question 25

Types of transitional cell cancer

Answer 25

Papillary - 50% are malignant | Non-papillary - all are malignant

Question 26

Appearance of transitional cell cancer

Answer 26

Multicentric | Bilateral

Question 27

Who gets bladder cancer?

Answer 27

Males >50

Question 28

Angiomyolipoma

Answer 28

Benign | Hamartoma: fragile BVs, fat, smooth muscle

Question 29

How to diagnose angiomyolipoma

Answer 29

CT | Biopsy (dangerous due to haemorrhage)

Question 30

Treatment of angiomyolipoma

Answer 30

Embolisation if bleed

Question 31

Oncocytoma

Answer 31

Benign, can look like malignant RCC | Central scar on CT

Question 32

Diagnosis of oncocytoma

Answer 32

CT central scar (strands radiate out) | Nephrectomy - high false negative rate of malignant

Question 33

Presentation of RCC

Answer 33

Loin pain Renal mass Frank haematuria Paraneoplastic: weight loss, bone pain, anaemia, HT, hypercalcaemia

Question 34

Who gets RCC?

Answer 34

Males 65-75

Question 35

Types of RCC

Answer 35

Adenocarcinoma of PCT Carcinoma (epithelial) Clear cell and papillary CD adenocarcinoma

Question 36

Syndrome which may lead to multiple, bialteral renal tumorus

Answer 36

VHL

Question 37

Diagnosis of RCC

Answer 37

US CT Biopsy

Question 38

How does RCC spread?

Answer 38

Haematogenous via renal vein | Mets to lung, liver, bone, brain

Question 39

Treatment of RCC

Answer 39

Surgery - total/partial nephrectomy | Biological therapies

Question 40

BXO

Answer 40

Balanitis Xerotica Obliterans Pre-malignant lesion Scarring of foreskin and up urethra, white demarcated line White patches, bleeding, pain

Question 41

Treatment of BXO

Answer 41

Circumcision Dilatation Glans resurfacing, skin graft

Question 42

SCC of penis in situ

Answer 42

Red velvety patches | Bowen's or Queyrat's (pre-malignant) = 5FU or circumcision

Question 43

Invasive SCC of penis

Answer 43

Older men, red raised area, fungating mass, foul smelling, phimosis (narrowing) HPV 16

Question 44

Treatment of invasive SCC of penis

Answer 44

Surgery Chemo Radio Nodes

Question 45

Germ cell tumours of testicles

Answer 45

Seminoma Teratoma ITGCN (intra-tubular germ cell neoplasia)

Question 46

Presentation of testicular cancer

Answer 46

Painless swelling, hard | Neck nodes, SOB, clavicular nodes

Question 47

Diagnosis of testicular cancer

Answer 47

US CXR CT

Question 48

AFP marker

Answer 48

Raised in teratoma with yolk sac elements

Question 49

HCG marker

Answer 49

Raised in teratoma with trophoblast components

Question 50

LDH and placental ALP markers

Answer 50

Raised in seminoma

Question 51

Who gets testicular cancer?

Answer 51

20-35 years | Undescended testes

Question 52

Where does testicular cancer mets to?

Answer 52

Kidneys

Question 53

Treatment of testicular cancer

Answer 53

Radiotherapy Chemotherapy Surgery