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Renal SB > Renal, Testicular and Penile Cancer > Flashcards

Renal, Testicular and Penile Cancer Flashcards

1
Q

what are the common renal tumours

A

Renal cell carcinoma
Oncocytoma
Angiomyolipoma

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2
Q

what are the common penile cancer

A

SCC

Carcinoma in situ

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3
Q

what are the common testicular cancer

A

Seminoma

Teratoma

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4
Q

what are the classifications of renal tumours

A

Benign
- Renal cysts, oncocytoma, angiomyolipoma

Renal Pelvis
- Transitional cell carcinoma

Renal Parenchyma
- Renal cell carcinoma

Embryonic
- Nephroblastoma (Wilm’s Tumour)

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5
Q

how are renal tumours discovered

A

tend to be incidental finding; tend to be US

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6
Q

features of benign renal cysts

A

70% of benign asymptomatic renal lesions
Single or multiple
1 in 10 people have a renal cysts

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7
Q

Ix of benign renal cysts

A

tend to be found incidentally in Ultrasound

Can give Contrast CT to define if where there is enhancement of cyst

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8
Q

features of angiomyolipoma

A

Benign (mostly)

Blood vessels, fat, muscle

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9
Q

Ix of angiomyolipoma

A

CT

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10
Q

what are complication of angiomyolipoma and why

A

haemorrhage - large blood supply from new bloods vessels, that are very weak
- called Wunderlich’s syndrome

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11
Q

Tx of angiomyolipoma

A

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.

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12
Q

what is Wunderlich’s syndrome

A

spontaneous nontraumatic renal haemorrhage occurs into the subcapsular and perirenal spaces

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13
Q

how does Wunderlich’s syndrome present

A

acute flank pain
flank mass
hypovolemic shock

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14
Q

what are Oncocytoma

A

Benign tumour
will not metastasise
but does appear similar to malignant tumour

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15
Q

Tx of Oncocytoma

A

nephrectomy - as cannot rule out that it could be a malignant tumour

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16
Q

what are classic findings of oncocytoma that is seen

A

CT scan - central scar

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17
Q

RCC presentation

A

Classic triad

  • loin pain
  • renal mass
  • frank haematuria

Found incidentally on imaging

Paraneoplastic syndrome associated with RCC
- Weight loss, anaemia, HT, hypercalcaemia

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18
Q

what is a RCC (pathology)

A

Adenocarcinoma of Proximal Collecting Tubule

Clear cell, papillary

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19
Q

what are causes of multifocal or bilateral RCC

A

Von Hippel-Lindau syndrome

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20
Q

use of USS in RCC

A

tends to find RCC incidentally on examination for another problem

not useful for diagnosis RCC

21
Q

Ix of RCC

A

1st - CT; triple phase contrast

Can Biopsy
BUT High false negative in RCC

22
Q

how do RCC mets appear on a chest x-ray of the lung

A

‘Cannon ball’ Mets

23
Q

where does the RCC metastasise to

A

Lungs
Liver
Bone
Brain

24
Q

Tx of RCC

A

1st - Radical Nephrectomy (inc. laparoscopic)
- Whole kidney within Gerota’s fascia

Partial Nephrectomy (nephron sparing) for T1 surgery

Radiofrequency ablation

25
Q

Tx of metastatic RCC

A

radio and chemo resistant

Tyrosine Kinase Inhibitor - Sunitinib

  • VEGF/PDGF inhibitors
  • reduces neo vasularization
26
Q

what are premalignant cutaneous lesions in penile cancer

A

Balanitis xerotica obliterans, leukoplakia

27
Q

what cancer are most common in penile cancer

A

Squamous cell carcinoma

Either:
Carcinoma in situ
Invasive squamous cell carcinoma

28
Q

what is Balanitis xerotica obliterans also known as

A

Lichenus sclerosus et atrophicus

29
Q

what are Sx of BXO

A

White patches, fissuring, bleeding, pain, scarring

Can extend up Prepuce, glans, urethral (meatus) extension

30
Q

Tx of BXO

A

Circumcision

31
Q

Squamous carcinoma in situ

A

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)

32
Q

Tx for Squamous carcinoma in situ

A

Circumcision (if prepuce alone)

Topical 5 fluorouracil

33
Q

presentation of invasive cancer of the penis

A

Often delayed up to 50%

Red raised area penis
Fungating mass, foul smelling
Phimosis

34
Q

what is phimosis

A

narrowing of the opening of the foreskin so that it cannot be retracted

35
Q

what is associated with penile cancer

A

HPV 16

36
Q

Ix of penile cancer

A

US

MRI - for invasion

37
Q

Tx of penile cancer

A

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

38
Q

what are the testicular germ cell tumours

A

Seminoma
Teratoma
ITGCN

39
Q

Clinical presentation of testicular cancers

A

Painless testicular swelling
Stoney hard
dyspnoea (lung mets)

40
Q

Ix for testicular cancer

A

1st - Ultrasound

CXR, CT Abdomen/Thorax for staging

41
Q

what are markers for testicular cancer

A

AFP
Never raised in pure seminoma

HCG
5-10% pure seminoma
Up to 60% teratoma

LDH
Tumour burden

42
Q

what are testicular cancer markers used for

A

monitor treatment

43
Q

Tx of testicular cancer

A

Orchidectomy

  • inguinal approach to prevent spread of the tumour
  • clamp spermatic cord to prevent spread of tumour cells
44
Q

who gets testicular cancer

A

Peak incidence 20-35 years

x30 risk with undescended testis

45
Q

what is raised 100% in Teratoma Trophoblastic

A

HCG

46
Q

where do testicular cancer metastasise to

A

lung

kidneys

47
Q

risk factors for testicular cancer

A

undescended testes
infant hernia
infertility

48
Q

does descending the testes make a difference in likelihood of getting testicular cancer

A

no

lowering them is to make them more easy to exam - still at risk of developing testicular cancer

Renal SB (15 decks)

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