Renal, Testicular and Penile Cancer Flashcards by S B

what are the common renal tumours

Renal cell carcinoma
Oncocytoma
Angiomyolipoma

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what are the common penile cancer

SCC

Carcinoma in situ

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what are the common testicular cancer

Seminoma

Teratoma

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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)

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how are renal tumours discovered

tend to be incidental finding; tend to be US

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features of benign renal cysts

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

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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

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features of angiomyolipoma

Benign (mostly)

Blood vessels, fat, muscle

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Ix of angiomyolipoma

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what are complication of angiomyolipoma and why

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

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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.

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what is Wunderlich’s syndrome

spontaneous nontraumatic renal haemorrhage occurs into the subcapsular and perirenal spaces

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how does Wunderlich’s syndrome present

acute flank pain
flank mass
hypovolemic shock

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what are Oncocytoma

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

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Tx of Oncocytoma

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

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what are classic findings of oncocytoma that is seen

CT scan - central scar

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RCC presentation

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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what is a RCC (pathology)

Adenocarcinoma of Proximal Collecting Tubule

Clear cell, papillary

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what are causes of multifocal or bilateral RCC

Von Hippel-Lindau syndrome

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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