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Renal > Renal, Testicular and Penile Cancer > Flashcards

Renal, Testicular and Penile Cancer Flashcards

1
Q

What are some tumours of the kidney?

A 
Benign = simple cysts, angiomyolipomas, oncocytoma
Malignant = renal cell carcinoma, transitional cell carcinoma, lymphoma
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2
Q

How common are oncocytomas of the kidney?

A

Account for 3-7% of all kidney tumours

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3
Q

What other renal tumour do oncocytomas look like radiologically?

A

Renal cell carcinomas

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4
Q

What is the appearance of oncocytomas?

A

Spherical, capsulated, brown/tan colour, has central scar, not known to metastasise

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5
Q

What are some histological features of oncocytomas?

A

Aggregates of eosinophilic cells, mitosis rare and cells packed with mitochondria

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6
Q

How do oncocytomas present?

A

Incidental finding in 85%

May present with loin pain or haematuria

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7
Q

How are oncocytomas investigated?

A

CT scan = spoke wheel pattern

Biopsy = can be uncertain, similar to chromophobe renal cell carcinoma

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8
Q

How are oncocytomas treated?

A

Same as renal cell carcinomas

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9
Q

What is the aetiology of angiomyolipomas?

A

80% sporadic = middle age females

20% associated with tuberous sclerosis

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10
Q

What is tuberous sclerosis?

A

Autosomal dominant condition = mental retardation, epilepsy, adenoma sebaceum, hamartomas, 80% will develop angiomyolipomas

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11
Q

What do angiomyolipomas contain?

A

Blood vessels, immature smooth muscle and fat

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12
Q

How do angiomyolipomas present?

A

Incidental finding in 50%

May present with loin pain, mass or haematuria

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13
Q

What is Wunderlich’s syndrome?

A

Occurs in 10% of patients with angiomyolipomas = massive retroperitoneal bleed

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14
Q

What investigations can be done for angiomyolipomas?

A 
US = bright echo pattern
CT = fatty tumour of low density
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15
Q

What is the treatment for angiomyolipomas?

A

4cm is considered cut off
Elective = embolization, partial nephrectomy
Emergency = embolization, emergency nephrectomy

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16
Q

What are renal cell carcinomas?

A

Adenocarcinomas of the renal cortex = believed to arise from proximal convoluted tubule

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17
Q

What is the appearance of renal cell carcinomas?

A

Tan coloured, solid, 10-25% contain cysts or are partially cystic

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18
Q

What is the histological classification of renal cell carcinomas?

A

Clear cell = 80%, loss of VHL
Papillary = 10-15%, multifocal in 40%
Chromophobe = 5%
Collecting duct = rare, young patients, poor prognosis
Medullary cell = young sickle cell patients, very poor prognosis

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19
Q

How are renal cell carcinomas graded?

A

From 1 to 4

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20
Q

What is T1 and T2 renal cell carcinoma?

A 
T1 = up to 7cm
T2 = >7cm confined to kidney
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21
Q

What is T3 and T4 renal cell carcinoma?

A 
T3 = extends beyond kidney into renal vein, perinephric fat, renal sinus and IVC
T4 = beyond Gerota's fascia into surrounding structure
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22
Q

What is the most lethal urological cancer?

A

Renal cell carcinoma = more common in men

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23
Q

What are the risk factors for developing renal cell carcinoma?

A

Smoking, renal failure and dialysis, obesity, hypertension, low socio-economic class, asbestos, cadmium, phenacetin

24
Q

What is VHL syndrome?

A

Autosomal dominant = 50% develop renal cell carcinoma, loss of both copies of tumour suppressor gene on short arm of chromosome 3p25

25
Q

What is the presentation of renal cell carcinoma?

A 
Haematuria, loin pain, mass = all three occur in less than 10%
Pyrexia of unknown origin = 8-9%
Paraneoplastic syndrome (30%), variocoele, anaemia (30%), hypertension (25%)
26
Q

What investigations can be done for renal cell carcinoma?

A

USS, CT chest/abdomen/pelvis for staging, FBC, liver and renal function

27
Q

How are small renal cell carcinomas <3cm treated?

A

Surveillance in elderly unfit patients

Ablation in fit elderly and selected young patients

28
Q

How are renal cell carcinomas >3cm treated?

A

Partial nephrectomy, radical nephrectomy

29
Q

How are large renal cell carcinomas treated?

A

Laparoscopic radical nephrectomy is gold standard

30
Q

What is the follow up for renal cell carcinomas?

A

FBC, renal and liver function, CT or USS + CXR = for 5-10 years

31
Q

What is the most common solid cancer in men aged 20-45?

A

Testicular cancer = seminomatous in age 35-45, non-seminomatous in age <35

32
Q

How curable is testicular cancer?

A

Very = most curable cancer

33
Q

What are some risk factors for testicular cancer?

A

Increased risk in contralateral testes if previous TC
Cryptorchidism = 5-10% of all TC patients
HIV and positive family history for TC

34
Q

By how much does cryptorchidism increase the risk of testicular cancer?

A

Doubles risk if orchidopexy before age 13

Five times higher risk if orchidopexy after age 13

35
Q

What cell type do the majority of testicular cancers occur in?

A

90% occur in germ cells

36
Q

What are the two main types of testicular cancers?

A

Seminoma = 48%
Non-seminomatous = 42%
Mixed germ cell tumour

37
Q

What are the different types of non-seminomatous and mixed germ cell testicular cancers?

A 
NS = teratoma, yolk sac, mixed, choriocarcinoma 
Mixed = sex cord stromal, Leydig cell, Sertoli cell, mixed
38
Q

How do testicular cancers present?

A

Scrotal lump, 5% have acute pain due to bleeding

10% present with symptoms of advanced disease = weight loss, neck lump, bone pain, chest symptoms

39
Q

When examining the testes, what side should you start with?

A

The normal side = must also assess involvement of the epididymis, spermatic cord and scrotal skin

40
Q

What are some features of a testicular cancer examination?

A

Asymmetry, slight scrotal discolouration, secondary hydrocele, abdominal mass in advanced disease
Hard, irregular non-tender mass = intra-testicular

41
Q

What imaging can be done for testicular cancer?

A

US of testicle

CT chest/abdomen for staging

42
Q

What are some serum tumour markers for testicular cancer?

A

aFP, B-HCG, LDH = raised in 50%

43
Q

What blood tests can be done for testicular cancer?

A

FBC, liver and renal function tests

44
Q

What is the treatment for testicular cancer?

A

Radical inguinal orchidectomy (offer sperm preservation)

Chase CT

45
Q

Do all testicular cancer patients get chemotherapy?

A

Yes = given as adjuvant even in non-metastatic disease

46
Q

When should serum tumour markers for testicular cancer be check post-operatively?

A

Re-check 1 week post-operatively if raised pre-operatively

47
Q

What kind of cancers affect the penis?

A

Squamous cell carcinoma (95%), Kaposi’s sarcoma, basal cell carcinoma, malignant melanoma = all are rare

48
Q

What are the risk factors for penile cancer?

A

Age 50-60, pre-malignant conditions present in 40%, phimosis, Asian/African/South American, HPV types 18 and 16, smoking, immunocompromised

49
Q

What sites are affected by penile cancer?

A 
Glans = 48%
Prepuce = 21%
Glans and prepuce = 9%
Coronal sulcus = 6%
Shaft = 2%
50
Q

How do penile cancers present?

A

Hard painless lump, rarely urinary retention or groin mass due to inguinal lymphadenopathy
15-50% delay seeing GP for >1 year

51
Q

What areas should be examined in suspected penile cancer?

A

Abdomen, inguinal region, external genitalia

52
Q

What investigations are done for penile cancer?

A

MRI = tumour depth

CT chest/abdomen/pelvis = advanced disease

53
Q

How are prepucial and glans penile cancer lesions treated?

A 
Prepucial = circumcision
Glans = glans resurfacing if superficial, glansectomy if deep
54
Q

How is more advanced penile cancer treated?

A

Total penile amputation with formation of penile urethrotomy

55
Q

When is an inguinal lymphadenectomy performed for penile cancer treatment?

A

If lymph nodes are involved

High risk of penile cancer

Renal (36 decks)

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