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RENAL > Renal, Testicular and Penile Cancer > Flashcards

Renal, Testicular and Penile Cancer Flashcards

1
Q

What benign lesions can be found in the kidney?

A

Simple cysts
Angiomyolipoma
Oncocytoma

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2
Q

What malignant cancers can arise in the kidney?

A

Renal cell carcinoma
Transitional Cell Carcinoma
Lymphoma

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3
Q

How do Oncocytomas appear macroscopically?

A

Spherical
capsulated
brown/tan coloured
central scar (stellate/spoke wheel shape)

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4
Q

What aggregates of what cell and organelles are seen histologically in oncocytoma?

A

eosinophilic cells

Oncocyte cells packed with mitochondria

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5
Q

How do most renal cancers present?

A

Incidental finding on a scan for something else

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6
Q

If patients are symptomatic with a renal cancer, what type of symptoms would they experience?

A

Loin pain
Haematuria
palpable mass

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7
Q

What group of patients usually get angiomyolipomas?

A

Middle aged females

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8
Q

What medical condition is known to have angiomyolipomas as a feature, along with epilepsy and subungual keratomas?

A

Tuberous sclerosis (autosomal dominant condition)

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9
Q

What appears pathologically in an angiomyolipoma?

A

Blood vessels (angio)
immature smooth muscle (myo)
fat (lipoma)

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10
Q

10% of patients with an angiomyolipoma experience a massive retroperitoneal bleed. What is this known as?

A

Wunderlich’s syndrome

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11
Q

How are angiomyolipomas investigated?

A

US - show a bright echo pattern

CT - fatty tumour (dark due to low density)

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12
Q

What treatment can be offered for angiomyolipomas?

A

If >4cm surgery is considered:

Embolization 
Partial nephrectomy (leave part of kidney)
Emergency = Radical nephrectomy (all out)
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13
Q

What are the different histological classifications of renal cell carcinoma?

A 
Clear cell carcinoma 
Papillary
Chromophobe
Collecting duct 
Medullary Cell
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14
Q

What genetic defect has been identified in relation to clear cell carcinoma?

A

Loss of Von Hippel Landau (VHL) gene on chromosome 3.

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15
Q

Who usually gets medullary cell renal carcinoma, and what is the prognosis of this?

A

Young sickle cell patients

very poor prognosis

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16
Q

Explain the boundaries of T1-4 staging in the kidney

A

T1 : Up to 7 cm
T2 : > 7 cm confined to the kidney
T3 : Extends beyond kidney into renal vein, perinephric fat, renal sinus, IVC
T4 : Beyond Gerotas fascia into surrounding structure.

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17
Q

What is thought to be the aetiology of renal cancers?

A 
Smoking 
Renal failure and dialysis
Obesity
Hypertension
Low socio-economic status
Genetic
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18
Q

Renal cancers can present with a varicocoele. What is this?

A

Dilation of veins in the scrotum (varicose veins)

Most commonly occurs on the LHS

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19
Q

Give examples of Paraneoplastic syndromes that patients may present with when they have renal cancer?

A 
Anaemia (from haematuria bleed)
Polycythaemia (less EPO production)
Hypertension
Cushing's 
Hypercalcaemia
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20
Q

How are RCC’s investigated?

A 
USS
CT Chest abdomen, pelvis for staging.
FBC 
Renal function
LFTs
21
Q

If an RCC is <3cm what is the recommended treatment?

A

For unfit elderly patients = surveillance

For fit elderly patients = ablation

22
Q

If an RCC is >3cm, what is the recommended treatment?

A 
Partial nephrectomy (robotic)
Radical nephrectomy if req'd
23
Q

How are large RCC’s handled?

A

Radical nephrectomy

Laparoscopic

24
Q

What investigations should be carried out as part of an RCC follow up?

A

FBC
Renal function
LFTs

Imaging CT / USS + CXR
(can do CT one year the US+CXR the next to minimise radiation)

25
What are the two main types of testicular cancer and when do they usually present?
Seminomatous 35-45y | Non-seminomatous < 35y
26
What parts of the world are most likely to develop testicular cancer?
White caucasians in Europe and USA.
27
If a man develops testicular cancer in one testis, it increases the risk of cancer in the contralateral testis. TRUE/FALSE?
TRUE
28
An orchidopexy can increase the risk of testicular cancer. TRUE/FALSE?
TRUE If <13y then doubles risk If >13y then 5x risk
29
What are the different histological types of non-seminimatous testicular tumours?
Teratoma Yolk Sac Choriocarcinoma Mixed
30
What are the different histological types of Mixed germ cell tumours?
Sex cord stromal Leydig cells Sertoli cells Mixed
31
How do patients with testicular cancer usually present?
``` Mainly = Scrotal lump Rarer: - acute pain due to bleeding - advanced disease => weight loss, neck lumps, chest symptoms or bone pain ```
32
What may be seen on an examination for testicular cancer?
Asymmetry or slight scrotal discoloration Hard, non-tender, irregular mass mostly intratesticular Secondary hydrocoele Abdominal mass – advanced disease
33
What imaging modalities are used to visualise and stage testicular cancer?
Ultrasound scan for testicle | CT Chest abdomen for staging
34
What tumour markers can you look for in the blood when diagnosing testicular cancer?
Alpha feto-protein B-HCG LPH
35
Why is the testicle removed via an incision into the abdominal wall in Radical Inguinal Orchidectomy?
So as to not expose the scrotal sac to the cancer
36
What must you offer before removing a testical due to cancer?
Offer sperm preservation
37
If any tumour markers were raised in the blood pre-operatively, how soon after the operation should they be checked?
1 week post op.
38
What is the most common type of penile cancer?
Squamous cell carcinoma (SCC) (95%)
39
What other types of penile cancer can occur?
Kaposi’s Sarcoma Basal Cell Carcinoma Malignant melanoma Sarcoma
40
At what age do most penile cancers present?
5-6 th decade
41
What factors can increase the risk of developing penile cancer?
``` Phimosis - Chronic inflmmation Geography : Asia, Africa, South America HPV 16 and 18 Smoking Immunosuppression ```
42
Where do most penile cancers arise?
Glans – 48 % | Prepuce (foreskin) – 21 %
43
How do most penile cancer patients present?
Hard painless lump Rare: - Urinary retention - groin mass (inguinal lymphadenopathy)
44
Examination looking for penile cancer involves assessment of what structures?
Abdomen inguinal region external genitalia
45
What investigations can be used to diagnose penile cancer?
MRI scan to assess tumour depth | CT scan abdomen, pelvis, chest (adv. disease)
46
What treatment is given if a penile cancer involves the prepuce?
Circumcision
47
How are glans lesions treated in penile cancer?
Superficial : Glans resurfacing (remove skin and graft) | Deep : Glansectomy
48
What treatment is offered in more advanced penile cancer?
Total penile amputation formation of perineal urethrostomy =.> have to sit down to pee
49
What treatment is given if patients experience inguinal lymphadenopathy related to penile cancer?
Inguinal lymphadenectomy | lymph nodes removed

RENAL (24 decks)

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