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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
Q

What are the two main types of testicular cancer and when do they usually present?

A

Seminomatous 35-45y

Non-seminomatous < 35y

26
Q

What parts of the world are most likely to develop testicular cancer?

A

White caucasians in Europe and USA.

27
Q

If a man develops testicular cancer in one testis, it increases the risk of cancer in the contralateral testis. TRUE/FALSE?

A

TRUE

28
Q

An orchidopexy can increase the risk of testicular cancer. TRUE/FALSE?

A

TRUE
If <13y then doubles risk
If >13y then 5x risk

29
Q

What are the different histological types of non-seminimatous testicular tumours?

A

Teratoma
Yolk Sac
Choriocarcinoma
Mixed

30
Q

What are the different histological types of Mixed germ cell tumours?

A

Sex cord stromal
Leydig cells
Sertoli cells
Mixed

31
Q

How do patients with testicular cancer usually present?

A 
Mainly = Scrotal lump
Rarer:
- acute pain due to bleeding
- advanced disease
=> weight loss, neck lumps, chest symptoms or bone pain
32
Q

What may be seen on an examination for testicular cancer?

A

Asymmetry or slight scrotal discoloration
Hard, non-tender, irregular mass mostly intratesticular
Secondary hydrocoele
Abdominal mass – advanced disease

33
Q

What imaging modalities are used to visualise and stage testicular cancer?

A

Ultrasound scan for testicle

CT Chest abdomen for staging

34
Q

What tumour markers can you look for in the blood when diagnosing testicular cancer?

A

Alpha feto-protein
B-HCG
LPH

35
Q

Why is the testicle removed via an incision into the abdominal wall in Radical Inguinal Orchidectomy?

A

So as to not expose the scrotal sac to the cancer

36
Q

What must you offer before removing a testical due to cancer?

A

Offer sperm preservation

37
Q

If any tumour markers were raised in the blood pre-operatively, how soon after the operation should they be checked?

A

1 week post op.

38
Q

What is the most common type of penile cancer?

A

Squamous cell carcinoma (SCC) (95%)

39
Q

What other types of penile cancer can occur?

A

Kaposi’s Sarcoma
Basal Cell Carcinoma
Malignant melanoma
Sarcoma

40
Q

At what age do most penile cancers present?

A

5-6 th decade

41
Q

What factors can increase the risk of developing penile cancer?

A 
Phimosis - Chronic inflmmation
Geography : Asia, Africa, South America
HPV 16 and 18 
Smoking
Immunosuppression
42
Q

Where do most penile cancers arise?

A

Glans – 48 %

Prepuce (foreskin) – 21 %

43
Q

How do most penile cancer patients present?

A

Hard painless lump
Rare:
- Urinary retention
- groin mass (inguinal lymphadenopathy)

44
Q

Examination looking for penile cancer involves assessment of what structures?

A

Abdomen
inguinal region
external genitalia

45
Q

What investigations can be used to diagnose penile cancer?

A

MRI scan to assess tumour depth

CT scan abdomen, pelvis, chest (adv. disease)

46
Q

What treatment is given if a penile cancer involves the prepuce?

A

Circumcision

47
Q

How are glans lesions treated in penile cancer?

A

Superficial : Glans resurfacing (remove skin and graft)

Deep : Glansectomy

48
Q

What treatment is offered in more advanced penile cancer?

A

Total penile amputation
formation of perineal urethrostomy
=.> have to sit down to pee

49
Q

What treatment is given if patients experience inguinal lymphadenopathy related to penile cancer?

A

Inguinal lymphadenectomy

lymph nodes removed

RENAL (24 decks)

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