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_Sem 3. Urinary NOTES > S11 L1, L2 - Carcinoma of the kidney and bladder, cancer and cysts > Flashcards

S11 L1, L2 - Carcinoma of the kidney and bladder, cancer and cysts Flashcards

1
Q

How does renal cell carcinoma present?

A

- Haematuria

  • May be incidental on imaging (25%)
  • If advance varicocele, weight loss, hypercalcaemia or PE
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2
Q

How does transitional cell carcinoma present?

A
  • Haematuria
  • Incidental on imaging
  • DVT, lymphoedema and weight loss if advanced
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3
Q

What are some differentials if a person presents with haematuria?

A
  • Painless and frank it is TCC or RCC until proven otherwise
  • Stones
  • Infection
  • Prostate cancer
  • Infection
  • Inflammation
  • GN
  • BPH
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4
Q

If a patient presents with haematuria what are some further questions in the history and some immediate examinations you can do?

A
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5
Q

What are some imaging techniques that may be used to investigate haematuria?

A
  • Flexible cystoscopy
  • Ultrasound/CT
  • Urine culture/cytology
  • Bloods
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6
Q

What is the rate of RCC and what is the prognosis?

A
  • 7th most commoin cancer
  • 95% of all upper urinary tract tumours
  • More common in white males
  • 30% metastasised at presentation
  • Most lethal urological malignancy and high recurrence rate 90-95%
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7
Q

What are some risk factors for developing RCC?

A
  • Smoking
  • Obesity
  • Dialysis
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8
Q

What are some ways that RCC metastasises?

A
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9
Q

How do we treat RCC?

A

Localised

  • Surveillance
  • Nephrectomy full or partial
  • Ablation

Advance Metastatic

  • Palliative with biological therapies targeting angiogenesis as chemo and radio resistant
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10
Q

What is the most common neoplasm of the bladder?

A

Risk factors:

  • Smoking
  • Occupational exposure in dye industry to arylamines
  • Handling crude oil
  • White male
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11
Q

Why may bladder TCC present with flank pain?

A
  • Tumour may be at vesicoureteric junction so obstruction and hydronephrosis
  • This can also lead to urinary retention if tumour at urethral orifice
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12
Q

How do we diagnose and stage bladder TCC?

A

- TURBT which also removes the cancer

  • Cystoscopy and full thickness biopsy
  • 75% are superficial T1 and 20% are muscle invasive
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13
Q

How can we treat bladder TCC?

A

Depends on staging

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14
Q

How can we treat muscle invasive bladder TCC?

A
  • Curative: radical cystectomy then reconstruct, and chemo

- Palliative: chemo/radio

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15
Q

How common is renal TCC and what is the risk factors?

A
  • 5% of renal malignancies
  • In epithelial cells lining renal calyces and renal pelvis
  • Smoking
  • Phenacetin abuse
  • Balkan’s nephropathy
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16
Q

How do we investigate for the suspicion of renal TCC after a patient has presented with haematuria?

A
17
Q

How do we treat renal TCC?

A
  • Nephro-ureterctomy
  • Systemic chemotherapy or biological therapys like atezolizumab if malignant
18
Q

What is the epidemiology and risk factors of prostate cancer?

A
  • Commonest cancer in men, rare <50 but 1 in 8 will have in a lifetime
  • Age
  • Family history and BRCA2 gene
  • Black>White>Asian
19
Q

What is the issue with using PSA for screening for prostate cancer?

A
  • Over diagnosis and treatment
  • Not cost effective
  • Will be raised up to 6 weeks after a UTI
  • Inflammation and large prostate will raise it e.g BPH
  • Urinary retention will alter it
  • Ejaculation will alter it
  • May have normal PSA but abnormal DRE
20
Q

How may a man with prostate cancer present?

A
  • Urinary symptoms due to wrapping around urethra e.g hesistancy
  • Bone pain as osteosclerotic metastases
  • Had PSA checked
  • DRE for other reason found it
  • Incidental on TURP
21
Q

How do we diagnose prostate cancer?

A

- Lower urinary tract symptoms (symptomatic): TURP

- Abnormal DRE or PSA (non-symptomatic): TRUS guided biopsy

22
Q

What factors decide how you are going to treat a prostate cancer?

A
  • Age
  • DRE showing T1/2 etc
  • PSA level
  • Biopsy and Gleason Grade
  • MRI/Bone scan for hot spot osteoblastic metastases
23
Q

How do we treat localised prostate cancer?

A
  • Surveillance every 6 months with DRE and PSA
  • Robotic radical prostatectomy
  • Radiotherapy
24
Q

How do we treat metastatic prostate cancer?

A

- Surgical castration

  • Hormone castration with LHRH agonists to exhaust the pituitary and lower testosterone levels but will be tumour flare at first
  • Chemotherapy
  • If palliative can give single dose radiotherapy, chemotherapy and pain relief
25
Q

What are the different zones of the prostate and where does prostate cancer mainly occur?

A
  • Cancer in peripheral zones which is next to rectum so found on DRE and if presents with urinary symptoms will mean it is late stage
  • BPH is in transitional zone which is central. Happens to most men by age of 80
26
Q

What hormone affects the prostates growth and function?

A

Testosterone from the testicles

27
Q

What part of the nephron does RCC mainly form in?

A

PCT

28
Q

What is the classic triad presentation of RCC?

A
  • Pain
  • Haematuria
  • Palbable mass
29
Q

What part of the kidney nephron is most likely to develop clear cell renal cell carcinoma?

A

PCT

30
Q

What is the most common cancer of the bladder and when might you develop another type?

A
  • TCC
  • Can get SCC with Schistomiasis due to the chronic irritation changing the cells to squamous
31
Q

What is a Wilms tumour?

A

Childhood neoplasm with good prognosis (nephroblastoma)

32
Q

If there is a tumour on the anterior aspect of the bladder, what type of tumour might you suspect?

A
  • Urachal cancer
  • Adenocarcinoma
33
Q

What are some of the paraneoplastic syndromes found in RCC?

A
34
Q

What is a urothelial cancer?

A

Carcinomas of the bladder, ureters, and renal pelvis, which occur at a ratio of 50:3:1

35
Q

GW:
1. Nephrotic syndrome indicators

  1. In nephrotic syndrome, what changes have occured to the glomerular basement membrane?
  2. Why does Fureosemide lead to hypokalaemia?
  3. What is renal angle tenderness?
A
  1. Low albumin, oedema, proteinuria
  2. •Damages the podocytes • Increase permeability to plasma proteins • Large proteins can ‘fall through the gaps’ • Enter the urine • Triad: Proteinuria, oedema, hypoalbuminaemia
  3. • Blockage of NaK2Cl, so more K is excreted • Na isn’t affected as can be reabosrbed in many other places past the loop of Henle. For more Na to be reabosrbed, ENaC and ROMK is increased, therefore worsening the problem as it causes even more K to be excreted • In the collecting duct - Na is reabsorbed
  4. renal angle tenderness - this is the same as loin pain

_Sem 3. Urinary NOTES (22 decks)

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