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Renal > Renal, Testicular and Penile Cancer > Flashcards

Renal, Testicular and Penile Cancer Flashcards

1
Q

what are the three main types of benign renal tumours

A

simple cysts
angiomyolipoma
oncocytoma

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2
Q

who gets angiomylipoma

A

80% sporadic in middle aged females

20% associated with tuberous sclerosis

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3
Q

what are the features of tuberous sclerosis

A 
autosomal dominant 
mental retardation 
epilepsy 
adenoma sebaceum 
hamartomas 
80% develop angiomyolipoma
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4
Q

what is the pathology of an angiomyolipoma

A

blood vessels, immature smooth muscle and fat

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5
Q

what is the presentation of an angiomyolipoma

A 
50% found incidentally 
loin pain 
haematuria 
mass 
10% wunderlichs syndrome= massive retroperitoneal bleed
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6
Q

what investigations for an angiomyolipoma

A

USS (bright echo pattern)

CT (fatty tumour of low density)

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7
Q

what is the treatment for an angiomyolipoma

A

> 4cm in considered to be removed as can spontaneously bleed when they reach this size
elective- embolisation/ partial nephrectomy
emergency- embolisation/ emergency nephrectomy

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8
Q

what is the pathology of an oncocytoma

A

spherical, capsulation, brown/ tan colour, has central scar, not know to metastasise
difficult to differentiate radiologically from an RCC

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9
Q

what is the histology of an oncocytoma

A

aggregates of eosinophils, similar to chromophobe RCC

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10
Q

what is the presentation of an oncocytoma

A

95% incidental
loin pain
haematuria
CT scan- spoke wheel pattern

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11
Q

what is the treatment for an oncocytoma

A

partial nephrectomy (doesn’t metastasise but hard to differentiate from RCC)

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12
Q

what are the most common types of malignant renal cancers

A

renal cell carcinoma
transitional cell carcinoma
lymphoma

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13
Q

what are the types of renal cell carcinomas

A 
clear cell (80%)
papillary (10-15%)
chromophobe (5%)
collecting duct
meduallary
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14
Q

what is a renal cell carcinoma

A

adenocarcinoma of the renal cortex- arises from the proximal convoluted tubules

can be solid/ complex cystic

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15
Q

what do renal cell carcinomas look like

A

tan colours
lobulated
solid
10-25% contain cysts

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16
Q

what gene predisposes you to clear cell carcinoma

A

loss of von hipple lindau (VHL) gene on chromosome 3

VHL syndrome (AD)- 50% get RCC, loss of both copies of a tumour suppressor gene at chromo 3p25

17
Q

what are 40%of papillary renal cancers

A

multifocal

18
Q

what are collecting duct renal cell carcinomas like

A

rare, affects young patients, poor prognosis

19
Q

what are medullary renal cell carcinomas like

A

rare, affects young sickle cell patients, very poor prognosis

20
Q

how do you grade and stage renal cell cancer

A

Grading 1-4

staging:
T1 upto 7cm
T2 >7cm confined to kidney T3 extends beyond kidney into renal vein, perinephric fat, renal sinus, IVC (more common on right as shorter renal vein)
T4 beyond gerotas fascia into surrounding fascia

21
Q

what is the most lethal of the urological cancers

A

renal cell carcinoma

22
Q

who gets renal cell carcinoma

A 
M5:F1
smoking 
renal failure and dialysis 
obesity 
hypertension 
low SE status 
asbestos 
cadium exposure 
phenacetin 
VHL syndrome
23
Q

what is the presentation of renal cell carcinoma

A 
haematuria 
loin pain 
mass 
(<10% have all three of these symptoms together) 
pryexia of unknown origin
varicocoele (dilates veins around the testes- more common on left testes, tumour blocks the left gonadal vein)
paraneoplastic syndrome in 30%
common to find tumours incidentally
24
Q

what paraneoplastic syndromes are seen in renal cancers

A

30% anaemia (haematuia, chronic disease)
5% polycythaemia (erythtopoetin)
25% hypertension (renin, renal artery compression)
hypoglycaemia (insulin)
cushings (ACTH)
10-20% hypercalcaemia (PTH like substance)
gynaecomastia, amenorrhoea, reduced libido, baldness (gonadotrophins)
stauffers syndrome (fever, anorexia, abnormal LFTs)

25
Q

what investigations for a renal carcinoma

A

USS
CT chest abdo and pelvis for staging
FBCs, renal and liver function tests

26
Q

what is the treatment for a renal cell carcinoma

A

small tumour <3cm- surveillance in elderly unfit patients
ablation in fit elderly or young unfit

> 3cm- partial nephrectomy, robotic technique, radical nephrectomy if young and other kidney working well

large tumours- radical nephrectomy, laparoscopic approach gold standard

follow up= FBC, renal and liver function tests, imaging CT/USS + CSR for 5-10 years (different imaging each year to minimise radiation)

27
Q

who gets testicular cancer

A

(most common solid tumour in) men 20-45
white caucasians in europe and USA
previous testicular cancer (increases risk for contralateral testes)
cryptorchidism (orchidopexy before 13 years of age 2 fold increase, orchidoplexy after 13 5 fold increase)
HIV
FHx

28
Q

what are the types of testicular cancer

A

seminomatous 42%
non seminomatous 48%
mixed germ layer

29
Q

what is the presentation of tescticular cancer

A

scrotal lump
delayed presentation occasionally seen
5% acute bleeding
10% symptoms of advanced disease (inc weight loss, neck lumps, chest symptoms, bone pain)

30
Q

what is seen on exam in testicular cancer

A 
asymmetry
slight scrotal discolouration 
examine normal side first 
hard non tender irregular mass 
mostly intratesticular 
assess involvement of the epididymis, spermatic chord and scortal skin
secondary hydrocoele

abdo mass= advanced disease (mets to paraaortic lymph nodes)

31
Q

what investigations for testicular cancer

A

USS testical
CT chest abdo and pelvis for staging
bloods- serum tumour markers (alpha feto protein, B-HCG, LDH), FBCs, LFTs, renal function tests

32
Q

what is the treatment for renal cancer

A

radical inguinal orchidectomy (dont go scrotal route as will expose new path to cancer)
offer sperm preservation and testicular prosthesis

recheck tumour markers if raised pre op
CT scan, oncology follow up

(can have chemo as adjuvant treatment)

33
Q

what are the types of penile cancer

A 
95% squamous cell cancer
kaposis sarcoma 
basal cell carcinoma 
MM
sarcoma (in HIV)

(all skin cancers)

34
Q

who gets penile cancers

A 
5th - 6th decade 
40% have pre malignant conditions (fibrosis)
phimosis (chronic inflammation)
asia, africa, south america 
HPV types 16 and 18 
smoking 
immunocompromised patients

(circumcision has a protective effect)

35
Q

where go you get penile cancers

A 
glans 48%
prepuce 31%
glans and prepuse 9%
coronal sulcus 6%
shaft 2%
36
Q

what is the presentation of penile cancer

A

hard painless lump
15-59% delayed presentation for >1 years (embarrassment, neglect, fear, ignorance)
rarely urinary retention or groin mass (inguinal lymphadenopathy)

37
Q

what investigations into penile cancer

A

MRI to asses tumour

CT abdo chest and pelvis in advanced disease

38
Q

what is the treatment for penile cancer

A 
prepucial lesions- circumscision 
glans lesions- superficial= glans resurfacing, deep= glansectomy 
advanced disease= total penile amputation with formation of a penile urethrostomy 
inguinal lymphadenectomy (if involved or high risk cancer)

Renal (27 decks)

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