Renal, Testicular and Penile cancer Flashcards
name some common benign renal tumours
angiomyolipoma, oncotyoma, fibroma (medulla), adenoma (cortex), juxtaglomerular tumour, cysts
name some common malignant renal cancers
renal cell carcinoma, transitional cell carcinoma, lymphoma
what is the most common renal cancer affecting children
Wilm’s tumour (nephroblastoma)
what age group commonly gets Wilm’s tumour and what mutation can cause it
ages 3-4, WT1 mutation
who commonly gets angiomyolipoma (AML)
middle aged females with tuberous sclerosis (80% will go on to develop AML)
what is tuberous sclerosis
autosomal dominant disease that causes benign tumours to grow all over the body
what are symptoms of AML
50% incidental finding, loin pain, haematuria, mass, Wunderlich’s syndrome (retroperitoneal bleed)
what investigations are done for AML and what is seen on each
biopsy: blood vessels, immature smooth muscle, fat // USS: bright echo pattern // CT: fatty tumour
what is the treatment for AML
surgery: embolisation + partial/ emergency nephrectomy
what are oncocytomas
spherical, capsulated, brown tumours that are radiologically similar to renal cell carcinomas (but do NOT met)
what is seen histologically in oncocytomas
eosinophilic cells with lots of mitochondria
what investigations are done for oncocytoma
CT: spoke wheel pattern // 85% are incidental findings
how do you treat oncocytomas
same management as renal cell carcinomas
where do renal cell carcinomas (RCC’s) arise
proximal convoluted tubules in the renal cortex
what are risks factors for developing RCC
male, renal failure, obesity, hypertension, VHL syndrome
what % of RCCs contain cysts
10-25%
what are the 5 histological classifications of RCCs
clear cell (80%), papillary (10-15%), chromophobe (5%), (collecting ducts and medullary cells)
what is seen on biopsy of clear cell RCCs
clear cytoplasms rich in glycoproteins
what is a big risk factor for clear cell RCC
obesity (and deletion on chromosome 3)
what is seen on biopsy of papillary RCCs
elongated papillae with foamy cells
what is seen on biopsy of chromophobe RCCs
large cells with defined borders
who is commonly affected by collecting duct RCCs
young patients - is rare, aggressive and has a poor prognosis
what is a grade 1 RCC
<7cm
what is a grade 2 RCC
> 7cm but confined to kidney
what is a grade 3 RCC
beyond kidney –> renal vein, perinephric fat, IVC
what is a grade 4 RCC
beyond gerotas fascia (fascia that encapsulates the kidney)
what is a common presentation of renal carcinoma
haematuria, loin pain and loin mass
what other symptoms can be seen in RCC
pyrexia, varicocele (testes vein enlargement), paranoplastic syndrome
what is paraneoplastic syndrome and what symptoms are seen in RCC
autoimmune disorders in response to neoplasms: anaemia, cushing’s, hypertension
what investigations are done for RCC
USS, CT, FBC, renal and LFTs
how would you manage an RCC <3cm
surgical ablation
how would you manage an RCC >3cm
partial nephrectomy
how would you manage a large RCC
radical nephrectomy - removal of whole kidney + surrounding fat
what age group does testicular cancer commonly affect
men aged 20-45
seminomatous testicular cancer is rare in what age group
before puberty - common 30-50
what are risk cancers for testicular cancer
undescended testes (cryptorchidism), previous TC, HIV, FH
Germ cell tumours are the most common type of TC, name 3 types of germ cell tumour
seminoma (55%), non-seminomatous, teratoma
aside from germ cell tumours, what tumours can also be present in TC
leydig and sertoli cell tumours
what is the most common presenting symptom of TC
a painless swelling/ nodule in one testicle that cannot be transilluminated +/- pain in abdomen (abdo mass = advanced disease)
what are systemic symptoms of TC
weight loss, neck lumps, gynaecomastia, bone pain
what investigations are done for TC
USS, CT, serum tumour markers, FBC
what tumour markers are used in TC
AFP, bHCG, LDH
what is the treatment of TC
1) radical inguinal orchiectomy 2) adjuvant chemo for non-seminomas and radio for seminomas
name some types of penile cancer
SCC, kaposi’s sarcoma, BCC, melanoma, sarcoma
what is the most common type of penile cancer
SCC (95%)
what are risk factors for penile cancer
50-60, phimosis, pre-malignant conditions, HPV, smoking
what is phimosis
foreskin is too tight and cannot be pulled back from foreskin
where is the most common site for penile cancer
glands (tip) 50%
what is a common presentation of penile cancer
hard, painless, red lump +/- smell, rarely urinary retention or mass
what investigations are done for penile cancer
biopsy, MRI/ USS for invasion
