Renal, Testicular and Penile Cancer Flashcards
What benign lesions can be found in the kidney?
Simple cysts
Angiomyolipoma
Oncocytoma
What malignant cancers can arise in the kidney?
Renal cell carcinoma
Transitional Cell Carcinoma
Lymphoma
How do Oncocytomas appear macroscopically?
Spherical
capsulated
brown/tan coloured
central scar (stellate/spoke wheel shape)
What aggregates of what cell and organelles are seen histologically in oncocytoma?
eosinophilic cells
Oncocyte cells packed with mitochondria
How do most renal cancers present?
Incidental finding on a scan for something else
If patients are symptomatic with a renal cancer, what type of symptoms would they experience?
Loin pain
Haematuria
palpable mass
What group of patients usually get angiomyolipomas?
Middle aged females
What medical condition is known to have angiomyolipomas as a feature, along with epilepsy and subungual keratomas?
Tuberous sclerosis (autosomal dominant condition)
What appears pathologically in an angiomyolipoma?
Blood vessels (angio)
immature smooth muscle (myo)
fat (lipoma)
10% of patients with an angiomyolipoma experience a massive retroperitoneal bleed. What is this known as?
Wunderlich’s syndrome
How are angiomyolipomas investigated?
US - show a bright echo pattern
CT - fatty tumour (dark due to low density)
What treatment can be offered for angiomyolipomas?
If >4cm surgery is considered:
Embolization Partial nephrectomy (leave part of kidney) Emergency = Radical nephrectomy (all out)
What are the different histological classifications of renal cell carcinoma?
Clear cell carcinoma Papillary Chromophobe Collecting duct Medullary Cell
What genetic defect has been identified in relation to clear cell carcinoma?
Loss of Von Hippel Landau (VHL) gene on chromosome 3.
Who usually gets medullary cell renal carcinoma, and what is the prognosis of this?
Young sickle cell patients
very poor prognosis
Explain the boundaries of T1-4 staging in the kidney
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.
What is thought to be the aetiology of renal cancers?
Smoking Renal failure and dialysis Obesity Hypertension Low socio-economic status Genetic
Renal cancers can present with a varicocoele. What is this?
Dilation of veins in the scrotum (varicose veins)
Most commonly occurs on the LHS
Give examples of Paraneoplastic syndromes that patients may present with when they have renal cancer?
Anaemia (from haematuria bleed) Polycythaemia (less EPO production) Hypertension Cushing's Hypercalcaemia
How are RCC’s investigated?
USS CT Chest abdomen, pelvis for staging. FBC Renal function LFTs
If an RCC is <3cm what is the recommended treatment?
For unfit elderly patients = surveillance
For fit elderly patients = ablation
If an RCC is >3cm, what is the recommended treatment?
Partial nephrectomy (robotic) Radical nephrectomy if req'd
How are large RCC’s handled?
Radical nephrectomy
Laparoscopic
What investigations should be carried out as part of an RCC follow up?
FBC
Renal function
LFTs
Imaging CT / USS + CXR
(can do CT one year the US+CXR the next to minimise radiation)
What are the two main types of testicular cancer and when do they usually present?
Seminomatous 35-45y
Non-seminomatous < 35y
What parts of the world are most likely to develop testicular cancer?
White caucasians in Europe and USA.
If a man develops testicular cancer in one testis, it increases the risk of cancer in the contralateral testis. TRUE/FALSE?
TRUE
An orchidopexy can increase the risk of testicular cancer. TRUE/FALSE?
TRUE
If <13y then doubles risk
If >13y then 5x risk
What are the different histological types of non-seminimatous testicular tumours?
Teratoma
Yolk Sac
Choriocarcinoma
Mixed
What are the different histological types of Mixed germ cell tumours?
Sex cord stromal
Leydig cells
Sertoli cells
Mixed
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
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
What imaging modalities are used to visualise and stage testicular cancer?
Ultrasound scan for testicle
CT Chest abdomen for staging
What tumour markers can you look for in the blood when diagnosing testicular cancer?
Alpha feto-protein
B-HCG
LPH
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
What must you offer before removing a testical due to cancer?
Offer sperm preservation
If any tumour markers were raised in the blood pre-operatively, how soon after the operation should they be checked?
1 week post op.
What is the most common type of penile cancer?
Squamous cell carcinoma (SCC) (95%)
What other types of penile cancer can occur?
Kaposi’s Sarcoma
Basal Cell Carcinoma
Malignant melanoma
Sarcoma
At what age do most penile cancers present?
5-6 th decade
What factors can increase the risk of developing penile cancer?
Phimosis - Chronic inflmmation Geography : Asia, Africa, South America HPV 16 and 18 Smoking Immunosuppression
Where do most penile cancers arise?
Glans – 48 %
Prepuce (foreskin) – 21 %
How do most penile cancer patients present?
Hard painless lump
Rare:
- Urinary retention
- groin mass (inguinal lymphadenopathy)
Examination looking for penile cancer involves assessment of what structures?
Abdomen
inguinal region
external genitalia
What investigations can be used to diagnose penile cancer?
MRI scan to assess tumour depth
CT scan abdomen, pelvis, chest (adv. disease)
What treatment is given if a penile cancer involves the prepuce?
Circumcision
How are glans lesions treated in penile cancer?
Superficial : Glans resurfacing (remove skin and graft)
Deep : Glansectomy
What treatment is offered in more advanced penile cancer?
Total penile amputation
formation of perineal urethrostomy
=.> have to sit down to pee
What treatment is given if patients experience inguinal lymphadenopathy related to penile cancer?
Inguinal lymphadenectomy
lymph nodes removed
