Renal, Testicular and Penile Cancer Flashcards
what are the three main types of benign renal tumours
simple cysts
angiomyolipoma
oncocytoma
who gets angiomylipoma
80% sporadic in middle aged females
20% associated with tuberous sclerosis
what are the features of tuberous sclerosis
autosomal dominant mental retardation epilepsy adenoma sebaceum hamartomas 80% develop angiomyolipoma
what is the pathology of an angiomyolipoma
blood vessels, immature smooth muscle and fat
what is the presentation of an angiomyolipoma
50% found incidentally loin pain haematuria mass 10% wunderlichs syndrome= massive retroperitoneal bleed
what investigations for an angiomyolipoma
USS (bright echo pattern)
CT (fatty tumour of low density)
what is the treatment for an angiomyolipoma
> 4cm in considered to be removed as can spontaneously bleed when they reach this size
elective- embolisation/ partial nephrectomy
emergency- embolisation/ emergency nephrectomy
what is the pathology of an oncocytoma
spherical, capsulation, brown/ tan colour, has central scar, not know to metastasise
difficult to differentiate radiologically from an RCC
what is the histology of an oncocytoma
aggregates of eosinophils, similar to chromophobe RCC
what is the presentation of an oncocytoma
95% incidental
loin pain
haematuria
CT scan- spoke wheel pattern
what is the treatment for an oncocytoma
partial nephrectomy (doesn’t metastasise but hard to differentiate from RCC)
what are the most common types of malignant renal cancers
renal cell carcinoma
transitional cell carcinoma
lymphoma
what are the types of renal cell carcinomas
clear cell (80%) papillary (10-15%) chromophobe (5%) collecting duct meduallary
what is a renal cell carcinoma
adenocarcinoma of the renal cortex- arises from the proximal convoluted tubules
can be solid/ complex cystic
what do renal cell carcinomas look like
tan colours
lobulated
solid
10-25% contain cysts
what gene predisposes you to clear cell carcinoma
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
what are 40%of papillary renal cancers
multifocal
what are collecting duct renal cell carcinomas like
rare, affects young patients, poor prognosis
what are medullary renal cell carcinomas like
rare, affects young sickle cell patients, very poor prognosis
how do you grade and stage renal cell cancer
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
what is the most lethal of the urological cancers
renal cell carcinoma
who gets renal cell carcinoma
M5:F1 smoking renal failure and dialysis obesity hypertension low SE status asbestos cadium exposure phenacetin VHL syndrome
what is the presentation of renal cell carcinoma
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
what paraneoplastic syndromes are seen in renal cancers
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)
what investigations for a renal carcinoma
USS
CT chest abdo and pelvis for staging
FBCs, renal and liver function tests
what is the treatment for a renal cell carcinoma
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)
who gets testicular cancer
(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
what are the types of testicular cancer
seminomatous 42%
non seminomatous 48%
mixed germ layer
what is the presentation of tescticular cancer
scrotal lump
delayed presentation occasionally seen
5% acute bleeding
10% symptoms of advanced disease (inc weight loss, neck lumps, chest symptoms, bone pain)
what is seen on exam in testicular cancer
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)
what investigations for testicular cancer
USS testical
CT chest abdo and pelvis for staging
bloods- serum tumour markers (alpha feto protein, B-HCG, LDH), FBCs, LFTs, renal function tests
what is the treatment for renal cancer
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)
what are the types of penile cancer
95% squamous cell cancer kaposis sarcoma basal cell carcinoma MM sarcoma (in HIV)
(all skin cancers)
who gets penile cancers
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)
where go you get penile cancers
glans 48% prepuce 31% glans and prepuse 9% coronal sulcus 6% shaft 2%
what is the presentation of penile cancer
hard painless lump
15-59% delayed presentation for >1 years (embarrassment, neglect, fear, ignorance)
rarely urinary retention or groin mass (inguinal lymphadenopathy)
what investigations into penile cancer
MRI to asses tumour
CT abdo chest and pelvis in advanced disease
what is the treatment for penile cancer
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)
