Renal + Urology

Question 1

1st line investigations in suspected prostate Ca?

Answer 1

Suspect prostate Ca in males with persistent lower urinary tract symptoms +/- ED +- visible haematuria.
1st line Inv: DRE + PSA
Refer anyone with a malignant feeling prostate on DRE or a raised PSA for their age to a specialist within 2 weeks (urgent)

Question 2

What indicates an urgent referral for suspected bladder cancer?

Answer 2

• 45 and over with unexplained VISIBLE haematuria without a urinary tract infection or that persists despite treatment of a urinary tract infection
• 60 and over with unexplained NON VISIBLE haematuria AND either dysuria or a raised WCC
• 60 and over with recurrent or persistent unexplained urinary tract infection

Question 3

What indicates urgent referral for suspected renal cancer ?

Answer 3

• 45 or older with unexplained visible haematuria in the absence of a UTI or despite treatment of a UTI

Question 4

What indicates an urgent referral for suspected testicular cancer ?

Answer 4

PAINLESS enlargement / change in shape / texture of testis
A painless lump is the most common presenting symptom of testicular Ca. Other possible symptoms include gynaecomastia (due to increased oestrogen: androgen ratio with leydig cell dysfunction occurs with both germ cell and non germ cell rumours) or hydrocoele

Question 5

Risk factors for testicular cancer?

Answer 5

• Male infertility (Increases risk of testicular Ca x 3)
• History of cryptorchidism
• History of mumps orchitis
• Family history of testicular Ca
• Klinefelters syndrome (XXY)

Question 6

The different types of testicular cancer?

Answer 6

95% are germ cell tumours (arise from the cells that produce sperm):
• Divided further into seminomas and non-seminomas
• Seminomas = slower growing, cause ^ HCG levels
• Nonseminomas = faster growing, include yolk sac carcinoma (most common testicular cancer in children), embryonal carcinoma, choriocarcinoma and teratoma (male version of dermoid cyst, contains all cell lines).

5% non germ cell:
• Leydig cell tumours - originate from the cells that produce testosterone, mainly benign but difficult to treat if spread outside of testicle
• Sertoli cell tumours - again mainly benign until spread outside testicle

Question 7

Tumour markers for measure in suspected testicular Ca ?

Answer 7

HCG (elevated in some seromas and non-seromas)
AFP (elevated in some non-seromas)
LDH
Oestrogen:androgen ratio increases in both germ cell and leydig cell tumours

Question 8

What indicates an urgent referral for suspected penile cancer?

Answer 8

• Penile mass / ulcer in the absence of STI or after STI has been treated
• Unexplained or persistent symptoms affecting the foreskin or glans