Renal, Testicular and Penile cancer

Question 1

name some common benign renal tumours

Answer 1

angiomyolipoma, oncotyoma, fibroma (medulla), adenoma (cortex), juxtaglomerular tumour, cysts

Question 2

name some common malignant renal cancers

Answer 2

renal cell carcinoma, transitional cell carcinoma, lymphoma

Question 3

what is the most common renal cancer affecting children

Answer 3

Wilm’s tumour (nephroblastoma)

Question 4

what age group commonly gets Wilm’s tumour and what mutation can cause it

Answer 4

ages 3-4, WT1 mutation

Question 5

who commonly gets angiomyolipoma (AML)

Answer 5

middle aged females with tuberous sclerosis (80% will go on to develop AML)

Question 6

what is tuberous sclerosis

Answer 6

autosomal dominant disease that causes benign tumours to grow all over the body

Question 7

what are symptoms of AML

Answer 7

50% incidental finding, loin pain, haematuria, mass, Wunderlich’s syndrome (retroperitoneal bleed)

Question 8

what investigations are done for AML and what is seen on each

Answer 8

biopsy: blood vessels, immature smooth muscle, fat // USS: bright echo pattern // CT: fatty tumour

Question 9

what is the treatment for AML

Answer 9

surgery: embolisation + partial/ emergency nephrectomy

Question 10

what are oncocytomas

Answer 10

spherical, capsulated, brown tumours that are radiologically similar to renal cell carcinomas (but do NOT met)

Question 11

what is seen histologically in oncocytomas

Answer 11

eosinophilic cells with lots of mitochondria

Question 12

what investigations are done for oncocytoma

Answer 12

CT: spoke wheel pattern // 85% are incidental findings

Question 13

how do you treat oncocytomas

Answer 13

same management as renal cell carcinomas

Question 14

where do renal cell carcinomas (RCC’s) arise

Answer 14

proximal convoluted tubules in the renal cortex

Question 15

what are risks factors for developing RCC

Answer 15

male, renal failure, obesity, hypertension, VHL syndrome

Question 16

what % of RCCs contain cysts

Answer 16

10-25%

Question 17

what are the 5 histological classifications of RCCs

Answer 17

clear cell (80%), papillary (10-15%), chromophobe (5%), (collecting ducts and medullary cells)

Question 18

what is seen on biopsy of clear cell RCCs

Answer 18

clear cytoplasms rich in glycoproteins

Question 19

what is a big risk factor for clear cell RCC

Answer 19

obesity (and deletion on chromosome 3)

Question 20

what is seen on biopsy of papillary RCCs

Answer 20

elongated papillae with foamy cells

Question 21

what is seen on biopsy of chromophobe RCCs

Answer 21

large cells with defined borders

Question 22

who is commonly affected by collecting duct RCCs

Answer 22

young patients - is rare, aggressive and has a poor prognosis

Question 23

what is a grade 1 RCC

Answer 23

<7cm

Question 24

what is a grade 2 RCC

Answer 24

> 7cm but confined to kidney

Question 25

what is a grade 3 RCC

Answer 25

beyond kidney --> renal vein, perinephric fat, IVC

Question 26

what is a grade 4 RCC

Answer 26

beyond gerotas fascia (fascia that encapsulates the kidney)

Question 27

what is a common presentation of renal carcinoma

Answer 27

haematuria, loin pain and loin mass

Question 28

what other symptoms can be seen in RCC

Answer 28

pyrexia, varicocele (testes vein enlargement), paranoplastic syndrome

Question 29

what is paraneoplastic syndrome and what symptoms are seen in RCC

Answer 29

autoimmune disorders in response to neoplasms: anaemia, cushing's, hypertension

Question 30

what investigations are done for RCC

Answer 30

USS, CT, FBC, renal and LFTs

Question 31

how would you manage an RCC <3cm

Answer 31

surgical ablation

Question 32

how would you manage an RCC >3cm

Answer 32

partial nephrectomy

Question 33

how would you manage a large RCC

Answer 33

radical nephrectomy - removal of whole kidney + surrounding fat

Question 34

what age group does testicular cancer commonly affect

Answer 34

men aged 20-45

Question 35

seminomatous testicular cancer is rare in what age group

Answer 35

before puberty - common 30-50

Question 36

what are risk cancers for testicular cancer

Answer 36

undescended testes (cryptorchidism), previous TC, HIV, FH

Question 37

Germ cell tumours are the most common type of TC, name 3 types of germ cell tumour

Answer 37

seminoma (55%), non-seminomatous, teratoma

Question 38

aside from germ cell tumours, what tumours can also be present in TC

Answer 38

leydig and sertoli cell tumours

Question 39

what is the most common presenting symptom of TC

Answer 39

a painless swelling/ nodule in one testicle that cannot be transilluminated +/- pain in abdomen (abdo mass = advanced disease)

Question 40

what are systemic symptoms of TC

Answer 40

weight loss, neck lumps, gynaecomastia, bone pain

Question 41

what investigations are done for TC

Answer 41

USS, CT, serum tumour markers, FBC

Question 42

what tumour markers are used in TC

Answer 42

AFP, bHCG, LDH

Question 43

what is the treatment of TC

Answer 43

1) radical inguinal orchiectomy 2) adjuvant chemo for non-seminomas and radio for seminomas

Question 44

name some types of penile cancer

Answer 44

SCC, kaposi's sarcoma, BCC, melanoma, sarcoma

Question 45

what is the most common type of penile cancer

Answer 45

SCC (95%)

Question 46

what are risk factors for penile cancer

Answer 46

50-60, phimosis, pre-malignant conditions, HPV, smoking

Question 47

what is phimosis

Answer 47

foreskin is too tight and cannot be pulled back from foreskin

Question 48

where is the most common site for penile cancer

Answer 48

glands (tip) 50%

Question 49

what is a common presentation of penile cancer

Answer 49

hard, painless, red lump +/- smell, rarely urinary retention or mass

Question 50

what investigations are done for penile cancer

Answer 50

biopsy, MRI/ USS for invasion