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Renal > Renal, tubular and penile cancer > Flashcards

Renal, tubular and penile cancer Flashcards

1
Q

How do you catergorise renal masses?

A

Beingin and Malignant (renal cell cancer - cortex: solid/ cyctic). transitional cell carcinoma, lymphoma (elderly pop.)

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2
Q

What are cycts?

A

simple fluid filled lesion

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3
Q

Oncocytoma

A

spherical

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4
Q

Radioloigcal

A

radiologically v diff to differentiate frm ohter cancers

main feature: Central scar

doent metastasise

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5
Q

Presentation of onco

A

loin pain, haematuria

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6
Q

What is the treatment fro oncocytoma?

A

ifsmal – partial nephrectomy

large - radical nephrectomy

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7
Q

Angiomiolipoma

A

sporadic in middle aged females

20% occurs in association with Tuberous sclerosis (autosomal dominant, mental retardtaion, epilepsy, hamartomas)

80% of TS develop AML

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8
Q

WHat is AML haemo?

A

blood vesserls, muscle and fat

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9
Q

How does CT of AML look like?

A

simply observe it, fatty tymour of low density

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10
Q

Presentation of AML

A

sometime s massive loin pain and haematuria, mass

Wunderlich syndrome - 10% (massive retroperitoneal bleed0

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11
Q

Investigation

A

US - bright echo pattern,

CT _ fatty tumour

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12
Q

Treatment

A

1-2 cm men - doesnt matter

<4 cm in pre-menopausal women –> need to be monitored as during pregnancy they can grow in size

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13
Q

Elective treatment for AML

A

Embolization(to decrease risk of bleeding), partial nephrectomy

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14
Q

Emergency treatment

A

Emvbolisation and emergency nephrectomy

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15
Q

Renal cell carcinoma

A

Adenocarcinoma of the renal cortex

Arises from the PCT of the nephron

tan coloured- solid and lobulated in gross appearance

10-25% contain cysts –> cyctsic strucutres

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16
Q

Histological classifical of RCC

A
  1. Conventional clear cell carcinoma (Gene of chromosome 3, loss of VHl –> they are predisposed to developing RCC)
  2. Papillary - 10-15% have it, can be found as a multifocal disease, can develop tumours on the toher side as well

3, Chromophobe - similar to benign but malignant, low risk of metastases, 5%

  1. collecting duct: rare, young patients, oin medulla and collectin gduct, very aggressive, they present with metastases

5.

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17
Q

Grading of RCC

A

grading - malignant potential of the tumour

1-4 (differentiation levels)

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18
Q

Staging of the RCC

A

size and extense of cancer

shorter renal vein on the right, hence more in the right side

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19
Q

What is the most lethal of urological cancers?

A

RCC

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20
Q

Who is RCC more common in?

A

Men

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21
Q

Modifiable risk factors in RCC

A

smoking,
obesity
hypertension

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22
Q

Non-modifiable risk factor in RCC

A

renal failure and dialysis

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23
Q

Which

A

loss of tumour suppressor gene in chromosome 3

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24
Q

PC of RCC

A

haematuria, loin pain and mass

pyrexia
varicoceole (more so on the left side - left testicular vein goes directly into the renal vein, when the renal vein gets blocked by the tumour, it blocks the testicular vein as well -->

paraneoplastic syndrome- hormones and mass produced that can cause other symtpoms as well

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25
Q

How are RCC found first?

A

Incidental finding

26
Q

Investigatio

A 
US - 
CT - kidney, abdomen and pelvis, chest --> to check ofr metastases
FBC
Renal and liver functions
Clotting
27
Q

Polycythaemia

A

erythropoetin

28
Q

What is stauffer syndrome?

A

abnormal liver function tests, they settle down once

29
Q

Treatment of RCC depends on what?

A

size and location

30
Q

Treamtment for RCC < 3cm

A

less than 3cm -
in old and frail –> just monitor them& and it is remains the same just leave it and keep checking 3-5 years

young - selected partial nephrectomy

old, healthy (either ablate with radiofrequency waves and burning the tumour, good cancer control in those < 3cm for 3-5 years )
radioablation in ppl fit elderly patient, selected younger apatients who are unfit

31
Q

benign size

A

< 3cm

32
Q

treatment >3cm

A

partial nephrectomy - more preferred in younger patients (40s - 50s), robotic technique

Radical nephrectomy - laparoscopically remove the whole kidney, low morbidity post-op

fit for surgery, 80 y/o, >3cm, healthy kidney - do radical nephrectomy

33
Q

treatment for large tumours

A

radical nephrectomy

34
Q

Risk in partial nephrectomy

A

bleeding

35
Q

80 y/o, recent MI, tumour 2.5 cm

A

just monitor

but if keep on something done - ablation

36
Q

45 y/o tumour 2.5 cm

younger patient

A

partial nephrectomy - gold standard,

ablation - optional

37
Q

mass 7 cm

A

laparoscopic nephrectomy

38
Q

tumour 15 cm

A

radical nephrectomy

39
Q

How would you follow up in patients?

A

Risk categorise and chose accordingly, decrease radiation

FBCand renal and liver function

if it turns out t be a chromophobe –>

clear cell - grade 2 -

40
Q

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

A

testicular cancer

41
Q

Seminomatous cancer

A

35-45 (surgeons)

42
Q

Non-seminomatous. teratomas

A

<35 (troops)

43
Q

what is the porgnosis of testicular cancer?

A

good

44
Q

Common in whom?

A

White caucasians in europe and USA

***very very rare in africana or asians

45
Q

Risk factors

A

contralateral testicle - previous testicular cancer

crytpochordism
orchidopexy before 13 y/i - 2x risk

orcidopexy after 13 y/o - x% increased risk

HIV - higher risk of seminoma

Family history

46
Q

Hisotological types of testicular

A

90% germ cells

47
Q

PC of testicular cancer

A

scrotal lump in shower, delayed presentation can happen

5% acute pain - bleeding in the testis

10% - advacned disease including weihgt loss, neck lumps, chest symptoms or bone pain

48
Q

On exam

A

always check the normal side first

abnormal - assymetry, non-tender hard testicle, irregular mass mostly intra-testicular
assymetry of slight scrota ldisclolouration
assess epidydmis, spermatic cord and scrotal skin

secondary hydrocoele
abdominal mass - advanced disease

49
Q

Investigations

A

US for the testicle
CT chest abdomen for staging

blood tests:
serum tumour markers - AFP, B-HCG, LDH, raised in 50% cases
not raised in all cases, and mostly in metastatic diseases it is raised
FBC
LFT
Renal function tests

50
Q

Treatment

A

Radical inguinal orchidectomy - inguinal approach, via inguinal canal, taking the testical out along as much length of the spermatic cord

not from the scrotum - dont want to expose another way for the cancer to take

51
Q

On exam

A

always check the normal side first

abnormal - assymetry, non-tender hard testicle, irregular mass mostly intra-testicular
assymetry of slight scrota ldisclolouration
assess epidydmis, spermatic cord and scrotal skin

secondary hydrocoele

IMP**abdominal mass - advanced disease

52
Q

Investigations

A

US for the testicle
CT chest abdomen for staging - done anyway regardless of the abdominal mass

blood tests:
serum tumour markers - AFP, B-HCG, LDH, raised in 50% cases
not raised in all cases, and mostly in metastatic diseases it is raised
FBC
LFT
Renal function tests

53
Q

Treatment

A

Radical inguinal orchidectomy - inguinal approach, via inguinal canal, taking the testical out along as much length of the spermatic cord

not from the scrotum - dont want to expose another way for the cancer to take

re-check tumour markers 1 weeks post op, if they are not going down do CT, further follow up oncologist –> some form of chemotherapy in lower doses given to increase prognosis

54
Q

Penile cancer

A

squamous cell cancer
95% - skin cancer

in the foreskin starts and then invades deeper into it

Kaposi’s sarcoma - HIV

BCC, malignant melanoma and sarcoma - rare

very rare

55
Q

Risk factors in penile cancer

A 
5th- 6 th decade
phimosis - chronic imflammation
geography - asia, africa, south america more commonly seen
HPV - strongly associated type 16 and 18
Smoking
Immunocompromised patient
56
Q

protective risk factor in penile cancer

A

circumsicion

57
Q

most common location

A

glans - 48%

prepuce

58
Q

PC

A

hard painless lump

15-50% - hihgh incidence of delayed presentation for > 1 year due to embarassment

rare - urinalry retention or groin mass (inguinal lymphadenopathy)

59
Q

Investigations

A

if small volume - not much done

MRI - if the glans skin involved and the corpora might be involved then do MR, tumour death

CT chest and abdomen - if advanced, if inguinal lymphadenopathy

60
Q

Prognosis pof malignnay penile cancer in 5 years

A

0%

61
Q

Treatment:

A

prepucial lesions
- circumcision

glans lesions - remove the skin over glans, put graft and let it take over, high risk that the undersurface of the foreskin in involved

deep - glasectomy

total penile amputation - supra-pubic catheter,

inguinal lymph present - inguinal lymphadenopathy, might have tiny metastases

Renal (21 decks)

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