Renal, Testicular And Penile Cancer

Question 1

Which kidney cancer has the worst outcome?

Answer 1

Renal cell carcinoma

Question 2

What are the features of an oncocytoma?

Answer 2

Benign
Radiologically difficult to differentiate from cancer
Has a “spoke wheel” pattern

Question 3

How does an oncocytoma present?

Answer 3

Incidental finding
Loin pain
Haematuria
Mx- just observe for a few years

Question 4

What are the features of angiomyolipoma?

Answer 4

80% in middle aged females
20% associated with tuberous sclerosis

Question 5

how does an angiomyolipoma present?

Answer 5

50% incidental
lion pain, haematuria, mass
wunderlichs syndrome- massive retroperitoneal bleed
4cm is considered the cut off for treatment
Mx- embolisation/nephrectomy

Question 6

what are the features of a renal cell carcinoma?

Answer 6

adenocarcinoma of the renal cortex
believed to arise from the proximal convoluted tubule
10-25% contain cysts

Question 7

what is associated with a conventional clear cell carcinoma?

Answer 7

VHL syndrome

Question 8

what are the different stages of a renal cell carcinoma?

Answer 8

1- up to 7cm
2- >7cm, confined to kidney
3- extends beyond kidney into vascular structures
4- beyond gerotas fascia into surrounding areas

Question 9

what are the risk factors of clear cell carcinoma?

Answer 9

male
smoking
renal failure/dialysis
obesity
hypertension
low socio-economic status, asbestos exposure
VHL syndrome (autosomal dominant)

Question 10

how does a clear cell carcinoma present?

Answer 10

haematuria, loin pain and mass (all three together in <10%)
pyrexia of unknown origin (10%)
varicocele
paraneoplastic syndrome

Question 11

What is gold standard imaging for a clear cell carcinoma?

Answer 11

CT

Question 12

What are the treatment options for a RCC

Answer 12

Small tumours <7cm
- surveillance
- partial nephrectomy

Large tumours >7cm
- radical nephrectomy (laparoscopic)

Question 13

What metastases are associated with RCC

Answer 13

“Cannon ball” metastases in the lung

Question 14

What are the features of testicular cancer?

Answer 14

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

Question 15

What is the clinical presentation of testicular cancer?

Answer 15

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)

Question 16

What is seen on examination in testicular cancer?

Answer 16

Asymmetry or slight scrotal discolouration
Hard, non tender, irregular mass mostly intratesticular
Abdo mass/lymphadenopathy=advanced disease

Question 17

What investigations are used in testicular cancer?

Answer 17

USS
CT chest/abdo for staging
Alpha feto protein
B-HCG
LDH
Tumour markers commonly raised in non-sematomatous

Question 18

What is the treatment for testicular cancer?

Answer 18

Radical inguinal orchidectomy
Re check tumour markers 1 week post op to see if reduced

Question 19

What are the features of penile cancer?

Answer 19

Rare in the UK
Usually a SCC
Can be caused by kaposis sarcoma

Question 20

What are the risk factors for penile cancer?

Answer 20

5-6th decade
Phimosis- chronic inflammation
HPV 16+18
Smoking
Immunocompromised
Affects Asia, Africa, South America

Question 21

What is the most common site of penile cancer?

Answer 21

Glans- 48%
Prepuce- 21%

Question 22

How does penile cancer present?

Answer 22

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

Question 23

What is the treatment for penile cancer?

Answer 23

Prepucial lesions- circumcision
Glans lesions- superficial= gland resurfacing, deep= glansectomy