Renal, Testicular and Penile Cancer Flashcards
what are the common renal tumours
Renal cell carcinoma
Oncocytoma
Angiomyolipoma
what are the common penile cancer
SCC
Carcinoma in situ
what are the common testicular cancer
Seminoma
Teratoma
what are the classifications of renal tumours
Benign
- Renal cysts, oncocytoma, angiomyolipoma
Renal Pelvis
- Transitional cell carcinoma
Renal Parenchyma
- Renal cell carcinoma
Embryonic
- Nephroblastoma (Wilm’s Tumour)
how are renal tumours discovered
tend to be incidental finding; tend to be US
features of benign renal cysts
70% of benign asymptomatic renal lesions
Single or multiple
1 in 10 people have a renal cysts
Ix of benign renal cysts
tend to be found incidentally in Ultrasound
Can give Contrast CT to define if where there is enhancement of cyst
features of angiomyolipoma
Benign (mostly)
Blood vessels, fat, muscle
Ix of angiomyolipoma
CT
what are complication of angiomyolipoma and why
haemorrhage - large blood supply from new bloods vessels, that are very weak
- called Wunderlich’s syndrome
Tx of angiomyolipoma
found incidentally > require no therapy (when small). Follow-up to assess for growth.
Larger AMLs, or those that have been symptomatic, can be electively embolised and/or resected with a partial nephrectomy.
what is Wunderlich’s syndrome
spontaneous nontraumatic renal haemorrhage occurs into the subcapsular and perirenal spaces
how does Wunderlich’s syndrome present
acute flank pain
flank mass
hypovolemic shock
what are Oncocytoma
Benign tumour
will not metastasise
but does appear similar to malignant tumour
Tx of Oncocytoma
nephrectomy - as cannot rule out that it could be a malignant tumour
what are classic findings of oncocytoma that is seen
CT scan - central scar
RCC presentation
Classic triad
- loin pain
- renal mass
- frank haematuria
Found incidentally on imaging
Paraneoplastic syndrome associated with RCC
- Weight loss, anaemia, HT, hypercalcaemia
what is a RCC (pathology)
Adenocarcinoma of Proximal Collecting Tubule
Clear cell, papillary
what are causes of multifocal or bilateral RCC
Von Hippel-Lindau syndrome
use of USS in RCC
tends to find RCC incidentally on examination for another problem
not useful for diagnosis RCC
Ix of RCC
1st - CT; triple phase contrast
Can Biopsy
BUT High false negative in RCC
how do RCC mets appear on a chest x-ray of the lung
‘Cannon ball’ Mets
where does the RCC metastasise to
Lungs
Liver
Bone
Brain
Tx of RCC
1st - Radical Nephrectomy (inc. laparoscopic)
- Whole kidney within Gerota’s fascia
Partial Nephrectomy (nephron sparing) for T1 surgery
Radiofrequency ablation
Tx of metastatic RCC
radio and chemo resistant
Tyrosine Kinase Inhibitor - Sunitinib
- VEGF/PDGF inhibitors
- reduces neo vasularization
what are premalignant cutaneous lesions in penile cancer
Balanitis xerotica obliterans, leukoplakia
what cancer are most common in penile cancer
Squamous cell carcinoma
Either:
Carcinoma in situ
Invasive squamous cell carcinoma
what is Balanitis xerotica obliterans also known as
Lichenus sclerosus et atrophicus
what are Sx of BXO
White patches, fissuring, bleeding, pain, scarring
Can extend up Prepuce, glans, urethral (meatus) extension
Tx of BXO
Circumcision
Squamous carcinoma in situ
Erythroplasia of Queyrat
- if on Glans, prepuce or shaft of penis
Bowen’s disease
- if its on other part of penis
Red velvety patches
( NB Zoon’s balanitis)
Tx for Squamous carcinoma in situ
Circumcision (if prepuce alone)
Topical 5 fluorouracil
presentation of invasive cancer of the penis
Often delayed up to 50%
Red raised area penis
Fungating mass, foul smelling
Phimosis
what is phimosis
narrowing of the opening of the foreskin so that it cannot be retracted
what is associated with penile cancer
HPV 16
Ix of penile cancer
US
MRI - for invasion
Tx of penile cancer
Surgery
- Total/ partial penectomy
- Reconstruction
Inguinal Nodes
- Prognosis, treatment options
- Imaging, radionuclide sentinal node biopsy
- Inguinal lymphadenectomy
Radiotherapy
- of Primary lesion, Lymph nodes but PALLIATIVE
Chemotherapy same
Combined treatment - for metastatic disease
what are the testicular germ cell tumours
Seminoma
Teratoma
ITGCN
Clinical presentation of testicular cancers
Painless testicular swelling
Stoney hard
dyspnoea (lung mets)
Ix for testicular cancer
1st - Ultrasound
CXR, CT Abdomen/Thorax for staging
what are markers for testicular cancer
AFP
Never raised in pure seminoma
HCG
5-10% pure seminoma
Up to 60% teratoma
LDH
Tumour burden
what are testicular cancer markers used for
monitor treatment
Tx of testicular cancer
Orchidectomy
- inguinal approach to prevent spread of the tumour
- clamp spermatic cord to prevent spread of tumour cells
who gets testicular cancer
Peak incidence 20-35 years
x30 risk with undescended testis
what is raised 100% in Teratoma Trophoblastic
HCG
where do testicular cancer metastasise to
lung
kidneys
risk factors for testicular cancer
undescended testes
infant hernia
infertility
does descending the testes make a difference in likelihood of getting testicular cancer
no
lowering them is to make them more easy to exam - still at risk of developing testicular cancer
