Renal, Testicular and Penile Cancer Flashcards
What are some tumours of the kidney?
Benign = simple cysts, angiomyolipomas, oncocytoma Malignant = renal cell carcinoma, transitional cell carcinoma, lymphoma
How common are oncocytomas of the kidney?
Account for 3-7% of all kidney tumours
What other renal tumour do oncocytomas look like radiologically?
Renal cell carcinomas
What is the appearance of oncocytomas?
Spherical, capsulated, brown/tan colour, has central scar, not known to metastasise
What are some histological features of oncocytomas?
Aggregates of eosinophilic cells, mitosis rare and cells packed with mitochondria
How do oncocytomas present?
Incidental finding in 85%
May present with loin pain or haematuria
How are oncocytomas investigated?
CT scan = spoke wheel pattern
Biopsy = can be uncertain, similar to chromophobe renal cell carcinoma
How are oncocytomas treated?
Same as renal cell carcinomas
What is the aetiology of angiomyolipomas?
80% sporadic = middle age females
20% associated with tuberous sclerosis
What is tuberous sclerosis?
Autosomal dominant condition = mental retardation, epilepsy, adenoma sebaceum, hamartomas, 80% will develop angiomyolipomas
What do angiomyolipomas contain?
Blood vessels, immature smooth muscle and fat
How do angiomyolipomas present?
Incidental finding in 50%
May present with loin pain, mass or haematuria
What is Wunderlich’s syndrome?
Occurs in 10% of patients with angiomyolipomas = massive retroperitoneal bleed
What investigations can be done for angiomyolipomas?
US = bright echo pattern CT = fatty tumour of low density
What is the treatment for angiomyolipomas?
4cm is considered cut off
Elective = embolization, partial nephrectomy
Emergency = embolization, emergency nephrectomy
What are renal cell carcinomas?
Adenocarcinomas of the renal cortex = believed to arise from proximal convoluted tubule
What is the appearance of renal cell carcinomas?
Tan coloured, solid, 10-25% contain cysts or are partially cystic
What is the histological classification of renal cell carcinomas?
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
How are renal cell carcinomas graded?
From 1 to 4
What is T1 and T2 renal cell carcinoma?
T1 = up to 7cm T2 = >7cm confined to kidney
What is T3 and T4 renal cell carcinoma?
T3 = extends beyond kidney into renal vein, perinephric fat, renal sinus and IVC T4 = beyond Gerota's fascia into surrounding structure
What is the most lethal urological cancer?
Renal cell carcinoma = more common in men
What are the risk factors for developing renal cell carcinoma?
Smoking, renal failure and dialysis, obesity, hypertension, low socio-economic class, asbestos, cadmium, phenacetin
What is VHL syndrome?
Autosomal dominant = 50% develop renal cell carcinoma, loss of both copies of tumour suppressor gene on short arm of chromosome 3p25
What is the presentation of renal cell carcinoma?
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%)
What investigations can be done for renal cell carcinoma?
USS, CT chest/abdomen/pelvis for staging, FBC, liver and renal function
How are small renal cell carcinomas <3cm treated?
Surveillance in elderly unfit patients
Ablation in fit elderly and selected young patients
How are renal cell carcinomas >3cm treated?
Partial nephrectomy, radical nephrectomy
How are large renal cell carcinomas treated?
Laparoscopic radical nephrectomy is gold standard
What is the follow up for renal cell carcinomas?
FBC, renal and liver function, CT or USS + CXR = for 5-10 years
What is the most common solid cancer in men aged 20-45?
Testicular cancer = seminomatous in age 35-45, non-seminomatous in age <35
How curable is testicular cancer?
Very = most curable cancer
What are some risk factors for testicular cancer?
Increased risk in contralateral testes if previous TC
Cryptorchidism = 5-10% of all TC patients
HIV and positive family history for TC
By how much does cryptorchidism increase the risk of testicular cancer?
Doubles risk if orchidopexy before age 13
Five times higher risk if orchidopexy after age 13
What cell type do the majority of testicular cancers occur in?
90% occur in germ cells
What are the two main types of testicular cancers?
Seminoma = 48%
Non-seminomatous = 42%
Mixed germ cell tumour
What are the different types of non-seminomatous and mixed germ cell testicular cancers?
NS = teratoma, yolk sac, mixed, choriocarcinoma Mixed = sex cord stromal, Leydig cell, Sertoli cell, mixed
How do testicular cancers present?
Scrotal lump, 5% have acute pain due to bleeding
10% present with symptoms of advanced disease = weight loss, neck lump, bone pain, chest symptoms
When examining the testes, what side should you start with?
The normal side = must also assess involvement of the epididymis, spermatic cord and scrotal skin
What are some features of a testicular cancer examination?
Asymmetry, slight scrotal discolouration, secondary hydrocele, abdominal mass in advanced disease
Hard, irregular non-tender mass = intra-testicular
What imaging can be done for testicular cancer?
US of testicle
CT chest/abdomen for staging
What are some serum tumour markers for testicular cancer?
aFP, B-HCG, LDH = raised in 50%
What blood tests can be done for testicular cancer?
FBC, liver and renal function tests
What is the treatment for testicular cancer?
Radical inguinal orchidectomy (offer sperm preservation)
Chase CT
Do all testicular cancer patients get chemotherapy?
Yes = given as adjuvant even in non-metastatic disease
When should serum tumour markers for testicular cancer be check post-operatively?
Re-check 1 week post-operatively if raised pre-operatively
What kind of cancers affect the penis?
Squamous cell carcinoma (95%), Kaposi’s sarcoma, basal cell carcinoma, malignant melanoma = all are rare
What are the risk factors for penile cancer?
Age 50-60, pre-malignant conditions present in 40%, phimosis, Asian/African/South American, HPV types 18 and 16, smoking, immunocompromised
What sites are affected by penile cancer?
Glans = 48% Prepuce = 21% Glans and prepuce = 9% Coronal sulcus = 6% Shaft = 2%
How do penile cancers present?
Hard painless lump, rarely urinary retention or groin mass due to inguinal lymphadenopathy
15-50% delay seeing GP for >1 year
What areas should be examined in suspected penile cancer?
Abdomen, inguinal region, external genitalia
What investigations are done for penile cancer?
MRI = tumour depth
CT chest/abdomen/pelvis = advanced disease
How are prepucial and glans penile cancer lesions treated?
Prepucial = circumcision Glans = glans resurfacing if superficial, glansectomy if deep
How is more advanced penile cancer treated?
Total penile amputation with formation of penile urethrotomy
When is an inguinal lymphadenectomy performed for penile cancer treatment?
If lymph nodes are involved
High risk of penile cancer
