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Renal > Renal, testicular and penile cancer > Flashcards

Renal, testicular and penile cancer Flashcards

1
Q

What are the common benign renal cancers?

A

Simple cyst
Angiomyolipoma
Oncocytoma

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2
Q

What are the common malignant renal cancers?

A

Renal cell carcinoma
Transitional cell
Lymphoma

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3
Q

Describe the macroscopic appearance of an oncocytoma?

A

Spherical
Capsulated
Brown/tan coloured
Central scar

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4
Q

Will oncocytomas metastasize?

A

No

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5
Q

Describe the histological appearance of oncocytomas?

A

Aggregates of eosinophilic cells, mitosis rare

Cells packed with mitochondria

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6
Q

How will an oncocytoma and angiomyolipoma present?

A

Majority are incidental findings

Can present with loin pain, haematuria and a mass

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7
Q

What will an oncocytoma look like on CT scan?

A

Spoke wheel pattern

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8
Q

What genetic condition is angiomyolipoma associated with?

A

Tuberous sclerosis

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9
Q

What inheritance is tuberous sclerosis?

A

Autosomal dominant

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10
Q

What is tuberous sclerosis associated with?

A 
Mental retardation
Epilepsy
Adenoma sebaceum 
Hamartoma 
Angiomyolipoma
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11
Q

What is wunderlich’s syndrome?

A

Massive retroperitoneal bleed associated with angiomyolipoma

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12
Q

What investigations should be done for an angiomyolipoma?

A

USS: bright echo
CT: fatty tumour of low density

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13
Q

What is the treatment for an angiomyolipoma?

A

4cm is cut off
Partial nephrectomy
Emergency radical nephrectomy

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14
Q

What is renal cell carcinoma?

A

Adenocarcinoma of renal cortex

Arises from proximal convoluted tubules

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15
Q

Describe the macroscopic appearance of a renal cell carcinoma

A

Yellow
Lobulated
Solid
1/4 contain cysts

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16
Q

What are the different histological classifications of renal cell carcinoma?

A 
Clear cell 
Papillary 
Chromophobe
Collecting duct
Medullary cells
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17
Q

What genetic condition is clear cell carcinoma associated with?

A

Loss of VHL gene on chromosome 3

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18
Q

What is the staging system for renal call carcinoma?

A

T1: up to 7cm
T2: >7cm confined to the kidney
T3: extends into the renal vein, perinephric fat, renal sinus and IVC

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19
Q

Which kidney is more likely to spread to the IVC?

A

Right kidney - renal vein is shorter and lies closer to the IVC

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20
Q

What is the aetiology of renal cell carcinoma?

A 
Smoking
Renal failure and dialysis 
Obesity
Hypertension 
Low socioeconomic class, asbestos, cadmium exposure, phenacetin 
Genetic: VHL
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21
Q

What is the classical presentation of renal cell carcinoma?

A 
Haematuria
Loin pain 
Mass 
Pyrexia of unknown origin
Variocele (left sided)
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22
Q

Why is a variocele commonly left sided in renal cell carcinoma?

A

Dilated veins around testis, the left testicular vein drains directly to the left renal vein

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23
Q

What paraneoplastic syndrome are associated with renal cell carcinoma?

A

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

24
Q

What is the treatment of renal cell carcinoma?

A

Small tumours less than 3cm: surveillance or ablation
More than 3cm: partial nephrectomy or radial nephrectomy
Large tumours: laparoscopic radial nephrectomy is gold standard

25
Q

What is the follow up for RCC?

A

FBC/ renal and liver function
CT/ USS + CXR
Duration for 5-10 years

26
Q

What are the different types of testicular cancer?

A

Seminoma of the seminiferous tubules (35-45)

Teratoma (<35)

27
Q

What are risk factors for testicular cancer?

A

Previous TC of contralateral testicle
Cryptorchidism
HIV
FMHx

28
Q

What do leydig cells do?

A

Secrete testosterone via LH

29
Q

What do sertoli cells do?

A

Spermatogenesis via FSH

30
Q

What is the clinical presentation of testicular cancer?

A

Scrotal lump
Acute pain due to haemorrhage
Advanced disease: wt loss, neck lumps, chest symptoms or bone pain

31
Q

What can be seen on clinical examination of testicular cancer?

A

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

32
Q

What imaging should be done in suspicion of testicular cancer?

A

USS of testicle

CT chest and abdo for staging

33
Q

What blood tests should be done in a testicular cancer workup?

A 
Alpha feto protein
Beta-HCG
LDH
FBC
LFTs
U&amp;Es
34
Q

What is the treatment of testicular cancer?

A

Radical inguinal orchiectomy through the deep inguinal ring

35
Q

What can cause penile cancer?

A 
Squamous cell carcinoma 
Kaposi sarcoma
BCC
Malignant melanoma
Sarcoma
36
Q

What causes kaposi sarcoma?

A

HHV 8 in HIV

37
Q

What are risk factors for penile cancer?

A 
5-6th decade
Phimosis 
HPV 16 and 18 
Smoking
Immunocompromised patients
38
Q

What are the common sites for penile cancer?

A

Gland
Prepuce
Shaft

39
Q

What is the presentation of penile cancer?

A

Hard painless lump

Urinary retention or groin mass (inguinal lymphadenopathy)

40
Q

What should be examined in penile cancer?

A

Abdomen
Inguinal region
External genitalia

41
Q

What imaging should be done in suspicion of penile cancer?

A

MRI to assess tumour depth

CT scan abdo, pelvis, chest

42
Q

Are the stats for penile cancer good?

A

NO

If patient presents with metastasis the 5-year survival is 0%

43
Q

What is the treatment for penile cancer?

A

Prepucial lesion: circumcision
Glans lesion: glans resurfacing or glansectomy
Advanced: total penile amputation
Inguinal lymphadenopathy

44
Q

What is balanits xerotical obliterans/

A

Chronic inflammation of the penis

Phimosis causing dysuria

45
Q

What increases the risk of papilloma?

A

HPV 16 and 18

Benign = 6 and 11

46
Q

What is the functional unit of the testis?

A 
Seminiferous tubules 
Sertoli cells (FSH) = spermatogenesis
Leydig cells (LH) = converts testosterone to DHEA
47
Q

What is a hydrocele?

A

Accumulation of fluid around the testis between the 2 layers of the tunica vaginalis - unicystic, smooth and fluid filled
Transilluminates

48
Q

What is a spermatocele?

A

Cystic change within the vas of the epididymis
Unknown cause
Feel fullness
Presents after self examination

49
Q

What is the varicocele?

A

Varicosities of venous plexus that drains the testis
Asymptomatic
Present as a lump

50
Q

What can predispose to a testicular torsion?

A

Bell clapper deformity

51
Q

What is a testicular torsion?

A

Urlologcial emergency

Testis and cord rotate around the arterial blood supply causing ischaemia and cell death

52
Q

What is a risk factor for a seminoma?

A

Undescended testes

53
Q

What testicular tumour is associated with aFP?

A

Yolk sac

54
Q

What testicular tumour is associated with raised beta hCG?

A

Trophoblastic choriocarcinoma

55
Q

What testicular tumour is associated with raised LDH?

A

Seminoma

56
Q

Which is the most aggressive form of testicular tumour?

A

Embryonal

57
Q

Which is more malignant, seminoma or non seminoma?

A

Non seminoma`

Renal (22 decks)

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