renal, testicular and penile cancer Flashcards
describe oncocytoma
benign spherical, capsulated, brown/tan cloured central scar on CT hallmark = aggregates of eosinophilic cells cells packed with mitochondria spoke wheel pattern on CT similar to chromophobe RCC on biopsy
how does oncocytome present?
loin pain
haematuria
often an incidental finding
how is oncocytoma managed?
same as RCC
what is angiomyolipoma associated with?
80% are sporadic in middle aged females
20% are associated with tuberous sclerosis (80% of tuberous sclerosis patients have angiomyolipoma)
angiomyolipoma pathology?
blood vessels
immature smooth muscle
fat (black shadowing on kidney)
features of tuberous sclerosis?
facial angiofibromas periungual fibromas hypomelanotic macules shagreen patches multiple retinal nodular hamartoma renal AMLs subependymal nodule and astrocytoma cardiac rhabdomyoma
how does angiomyolipoma present?
loin pain haematuria mass often incidental wunderlich's syndrome occurs in 10% (massive retroperitoneal bleed)
investigation of angiomyolipoma?
US - bright echo pattern
CT - fatty tumour of low density
management of angiomyolipoma?
4cm is considered the cut off for needing treatment (<4cm does not need treatment)
elective = embolization/partial nephrectomy
emergency = embolization ; emergency nephrectomy
when is angiomyolipoma monitored?
in pre-menopausal women as it can increase in size during pregnancy and cause problems
describe renal cell carcinoma
an adenocarcinoma of the renal cortex believed to arise from proximal convoluted tube
featuers of RCC?
tan coloured
lobulated
solid
10-25% contain cysts
classification of renal cell carcinoma?
conventional clear cell (80%) - due to loss of VHL gene on short of chromosome 3
papillary (10-15%) - 40% are multifocal
chromophobe (5%)
collecting duct - rare, young patients, poor prognosis
medullary cell - young sickle cell patients, very poor prognosis
grading of renal cancer?
1-4
- grading = prognosis
staging of renal cancer?
T1 = up to 7cm T2 = >7cm confined to kidney T3 = extends beyond kidney into renal vein, perinephric fat, renal sinus, IVC (more common on right side as shorter renal vein?) T4 = beyond gerotas fascia into surrounding structure
risk factors for RCC?
male smoking renal failure and dialysis obesity hypertension low socioeconomic status asbestos genetic (VHL, AD syndrome)
how does RCC present?
haematuria loin pain mass pyrexia of unknown origin variocele paraneoplastic syndrome (anaemia, polycthaemia, hypertension, hypoglycaemia, cushings, hypercalcaemia, gynaecomastia, staiffer's syndrome)
how can RCC cause variocele?
usually on the left
if cancer is in left renal vein, left gonadal vein drains into left renal so blockage causes back pressure and variocele in left testicle
investigations in RCC?
US
CT of chest abdomen, pelvis for staging
FBC
renal and liver function
treatment of RCC <3cm?
surveillance in elderly and unfit
ablation techniques in fit elderly and selected young patients
treatment of RCC >3cm?
partial nephrectomy (gold standard in young patient?) radical nephrectomy (whole kidney removed - easier and safer surgery, quicker recovery time)
management of large tumours?
radical nephrectomy
laparoscopic approach = gold standard
follow up for RCC after treatment?
FBC/renal and liver functions
imaging CT/US + CXR
duration = 5-10 years follow up
who is testicular cancer most common in?
most common solid cancer in men 20-45 white Caucasians in Europe and USA cryptorchidism (undescended testicle) - subsequent orchidoplexy can reduce risk if performed before 13 yrs old HIV family history previous cancer in other testicle
3 types of testicular cancer?
seminomatous (most common)
non-seminomatous
mixed germ cell tumour
types of non-semiomatous?
teratoma
yolk sac
choriocarcinoma
how does testicular cancer present?
scrotal lump
5% have acute pain due to bleeding
only 10% have systemic symptoms of advanced disease (weight loss, chest symptoms, neck lumphs, bone pain)
examination?
asymmetrical or slight scrotal discolouraion
hard, non-tender irregular mass (mostly intratesticular)
assess involvement of epididymis, spermaic cord and scrotal skin
secondary hydrocele
abdominal mass = advanced disease
investigation of testicular cancer?
imaging (US of testicle, CT chest for staing)
blood tests
- serum tumour markers (alpha feto protein, B - HCG, LDH)
- FBC
- liver function tests
- renal function tests
how is testicular cancer managed?
radiacal inguinal orchidectomy (offer sperm preservation and prosthesis)
re-check tumour markers 1 week post-op if they were elevated pre-op
chase CT scan if metastatic disease is suspected
further follow up by oncologist (chemotherapy as adjuvant treatment)
treatment if testicular cancer is metastatic?
chemotherapy first
what is penile cancer?
basically a skin cancer
95% are squamous cell carcinoma
types of penile cancer?
95% are squamous cell kaposis carcinoma basal cell carcinoma melanoma sarcoma
risk factors for penile cancer?
5-6th decade pre-malignancy conitions phimosis (chronic inflammation) asia, Africa, south America HPV (type 16 and 18) smoking immunocompromised
how does circumcision affect penile cancer risk?
lowers risk
where does penile cancer uually occur?
most on the glans
how does penile cancer present?
hard painless lump
15-50% delayed presentation for >1 year due to embarrassment, fear etc
can rarely get urinary retention or groin mass (due to inguinal lymphadenopathy)
examination of penile cancer?
abdomen
inguinal region
external genitalia
(looking for lymph nodes)
investigation of penile cancer?
CT scan abdomen, pelvis, chest in advanced disease
how is prepucial lesion penile cancer managed?
circumcision
how are glans lesions managed?
superficial = glans resurfacing deep = glansectomy
how is more advanced penile cancer managed?
total penile amputation with formation of penile urethrostomy
how is lymph node involvement in penile cancer managed?
inguinal lymphadenectomy
