Renal, testicular and penile cancer Flashcards
What are the common benign renal cancers?
Simple cyst
Angiomyolipoma
Oncocytoma
What are the common malignant renal cancers?
Renal cell carcinoma
Transitional cell
Lymphoma
Describe the macroscopic appearance of an oncocytoma?
Spherical
Capsulated
Brown/tan coloured
Central scar
Will oncocytomas metastasize?
No
Describe the histological appearance of oncocytomas?
Aggregates of eosinophilic cells, mitosis rare
Cells packed with mitochondria
How will an oncocytoma and angiomyolipoma present?
Majority are incidental findings
Can present with loin pain, haematuria and a mass
What will an oncocytoma look like on CT scan?
Spoke wheel pattern
What genetic condition is angiomyolipoma associated with?
Tuberous sclerosis
What inheritance is tuberous sclerosis?
Autosomal dominant
What is tuberous sclerosis associated with?
Mental retardation Epilepsy Adenoma sebaceum Hamartoma Angiomyolipoma
What is wunderlich’s syndrome?
Massive retroperitoneal bleed associated with angiomyolipoma
What investigations should be done for an angiomyolipoma?
USS: bright echo
CT: fatty tumour of low density
What is the treatment for an angiomyolipoma?
4cm is cut off
Partial nephrectomy
Emergency radical nephrectomy
What is renal cell carcinoma?
Adenocarcinoma of renal cortex
Arises from proximal convoluted tubules
Describe the macroscopic appearance of a renal cell carcinoma
Yellow
Lobulated
Solid
1/4 contain cysts
What are the different histological classifications of renal cell carcinoma?
Clear cell Papillary Chromophobe Collecting duct Medullary cells
What genetic condition is clear cell carcinoma associated with?
Loss of VHL gene on chromosome 3
What is the staging system for renal call carcinoma?
T1: up to 7cm
T2: >7cm confined to the kidney
T3: extends into the renal vein, perinephric fat, renal sinus and IVC
Which kidney is more likely to spread to the IVC?
Right kidney - renal vein is shorter and lies closer to the IVC
What is the aetiology of renal cell carcinoma?
Smoking Renal failure and dialysis Obesity Hypertension Low socioeconomic class, asbestos, cadmium exposure, phenacetin Genetic: VHL
What is the classical presentation of renal cell carcinoma?
Haematuria Loin pain Mass Pyrexia of unknown origin Variocele (left sided)
Why is a variocele commonly left sided in renal cell carcinoma?
Dilated veins around testis, the left testicular vein drains directly to the left renal vein
What paraneoplastic syndrome are associated with renal cell carcinoma?
Anaemia: haematuria or chronic disease
Polycythaemia: erythropoietin
Hypertension: renin, renal artery compression
Hypoglycaemia: insulin
Cushings syndrome: ACTH
Hypercalcaemia: PTHrP
Gynaecomastia, amenorrhoea, reduced lipido, baldness: gonadotropohins
Stauffer syndrome: fever, anorexia, abnormal LFTs
What is the treatment of renal cell carcinoma?
Small tumours less than 3cm: surveillance or ablation
More than 3cm: partial nephrectomy or radial nephrectomy
Large tumours: laparoscopic radial nephrectomy is gold standard
What is the follow up for RCC?
FBC/ renal and liver function
CT/ USS + CXR
Duration for 5-10 years
What are the different types of testicular cancer?
Seminoma of the seminiferous tubules (35-45)
Teratoma (<35)
What are risk factors for testicular cancer?
Previous TC of contralateral testicle
Cryptorchidism
HIV
FMHx
What do leydig cells do?
Secrete testosterone via LH
What do sertoli cells do?
Spermatogenesis via FSH
What is the clinical presentation of testicular cancer?
Scrotal lump
Acute pain due to haemorrhage
Advanced disease: wt loss, neck lumps, chest symptoms or bone pain
What can be seen on clinical examination of testicular cancer?
Asymmetry or slight scrotal discoloration
Examine normal side first
Hard, non tender, irregular mass mostly intratesticular
Assess involvement of epididymis, spermatic cord and scrotal skin
Secondary hydrocele
Abdo exam: advanced disease (para-aortic lymph nodes)
Do chest exam as testicular cancer commonly metastasizes to there
What imaging should be done in suspicion of testicular cancer?
USS of testicle
CT chest and abdo for staging
What blood tests should be done in a testicular cancer workup?
Alpha feto protein Beta-HCG LDH FBC LFTs U&Es
What is the treatment of testicular cancer?
Radical inguinal orchiectomy through the deep inguinal ring
What can cause penile cancer?
Squamous cell carcinoma Kaposi sarcoma BCC Malignant melanoma Sarcoma
What causes kaposi sarcoma?
HHV 8 in HIV
What are risk factors for penile cancer?
5-6th decade Phimosis HPV 16 and 18 Smoking Immunocompromised patients
What are the common sites for penile cancer?
Gland
Prepuce
Shaft
What is the presentation of penile cancer?
Hard painless lump
Urinary retention or groin mass (inguinal lymphadenopathy)
What should be examined in penile cancer?
Abdomen
Inguinal region
External genitalia
What imaging should be done in suspicion of penile cancer?
MRI to assess tumour depth
CT scan abdo, pelvis, chest
Are the stats for penile cancer good?
NO
If patient presents with metastasis the 5-year survival is 0%
What is the treatment for penile cancer?
Prepucial lesion: circumcision
Glans lesion: glans resurfacing or glansectomy
Advanced: total penile amputation
Inguinal lymphadenopathy
What is balanits xerotical obliterans/
Chronic inflammation of the penis
Phimosis causing dysuria
What increases the risk of papilloma?
HPV 16 and 18
Benign = 6 and 11
What is the functional unit of the testis?
Seminiferous tubules Sertoli cells (FSH) = spermatogenesis Leydig cells (LH) = converts testosterone to DHEA
What is a hydrocele?
Accumulation of fluid around the testis between the 2 layers of the tunica vaginalis - unicystic, smooth and fluid filled
Transilluminates
What is a spermatocele?
Cystic change within the vas of the epididymis
Unknown cause
Feel fullness
Presents after self examination
What is the varicocele?
Varicosities of venous plexus that drains the testis
Asymptomatic
Present as a lump
What can predispose to a testicular torsion?
Bell clapper deformity
What is a testicular torsion?
Urlologcial emergency
Testis and cord rotate around the arterial blood supply causing ischaemia and cell death
What is a risk factor for a seminoma?
Undescended testes
What testicular tumour is associated with aFP?
Yolk sac
What testicular tumour is associated with raised beta hCG?
Trophoblastic choriocarcinoma
What testicular tumour is associated with raised LDH?
Seminoma
Which is the most aggressive form of testicular tumour?
Embryonal
Which is more malignant, seminoma or non seminoma?
Non seminoma`
