Renal, Testicular And Penile Cancer Flashcards
Which kidney cancer has the worst outcome?
Renal cell carcinoma
What are the features of an oncocytoma?
Benign
Radiologically difficult to differentiate from cancer
Has a “spoke wheel” pattern
How does an oncocytoma present?
Incidental finding
Loin pain
Haematuria
Mx- just observe for a few years
What are the features of angiomyolipoma?
80% in middle aged females
20% associated with tuberous sclerosis
how does an angiomyolipoma present?
50% incidental
lion pain, haematuria, mass
wunderlichs syndrome- massive retroperitoneal bleed
4cm is considered the cut off for treatment
Mx- embolisation/nephrectomy
what are the features of a renal cell carcinoma?
adenocarcinoma of the renal cortex
believed to arise from the proximal convoluted tubule
10-25% contain cysts
what is associated with a conventional clear cell carcinoma?
VHL syndrome
what are the different stages of a renal cell carcinoma?
1- up to 7cm
2- >7cm, confined to kidney
3- extends beyond kidney into vascular structures
4- beyond gerotas fascia into surrounding areas
what are the risk factors of clear cell carcinoma?
male
smoking
renal failure/dialysis
obesity
hypertension
low socio-economic status, asbestos exposure
VHL syndrome (autosomal dominant)
how does a clear cell carcinoma present?
haematuria, loin pain and mass (all three together in <10%)
pyrexia of unknown origin (10%)
varicocele
paraneoplastic syndrome
What is gold standard imaging for a clear cell carcinoma?
CT
What are the treatment options for a RCC
Small tumours <7cm
- surveillance
- partial nephrectomy
Large tumours >7cm
- radical nephrectomy (laparoscopic)
What metastases are associated with RCC
“Cannon ball” metastases in the lung
What are the features of testicular cancer?
Most common solid tumour in men aged 20-45
Teratoma affects <35, seminomatous>35 (better outcome)
Undescended testes=higher risk
HIV and family history are also a risk factor
What is the clinical presentation of testicular cancer?
Scrotal lump
Delayed pres often
5% have acute pain
10% present with advanced disease including weight loss, chest symptoms and bone pain (typically in Ptnts with undescended testes)
What is seen on examination in testicular cancer?
Asymmetry or slight scrotal discolouration
Hard, non tender, irregular mass mostly intratesticular
Abdo mass/lymphadenopathy=advanced disease
What investigations are used in testicular cancer?
USS
CT chest/abdo for staging
Alpha feto protein
B-HCG
LDH
Tumour markers commonly raised in non-sematomatous
What is the treatment for testicular cancer?
Radical inguinal orchidectomy
Re check tumour markers 1 week post op to see if reduced
What are the features of penile cancer?
Rare in the UK
Usually a SCC
Can be caused by kaposis sarcoma
What are the risk factors for penile cancer?
5-6th decade
Phimosis- chronic inflammation
HPV 16+18
Smoking
Immunocompromised
Affects Asia, Africa, South America
What is the most common site of penile cancer?
Glans- 48%
Prepuce- 21%
How does penile cancer present?
Hard painless lump
Usually delayed presentation by >1 year
Rarely presents with urinary retention or groin mass (inguinal lymphadenopathy)
Ix- MRI to assess tumour depth
- CT abdo, pelvis, chest in advanced disease
What is the treatment for penile cancer?
Prepucial lesions- circumcision
Glans lesions- superficial= gland resurfacing, deep= glansectomy
