S11) Urological Cancers Flashcards
How does one assess haematuria?
- Visible changes
- Non visible changes: microscopy & urine dipstick
What is the differential diagnosis of haematuria?
- Urological
I. Cancer
II. Other – stones, infection, inflammation, BPH
- Nephrological (glomerular)
Describe the key components of the history of a patient presenting with haematuria
- Smoking
- Occupation
- Painful/painless
- Other LUTS
- Family history
How would one examine a patient presenting with haematuria?
- BP
- Abdominal mass
- Varicocele
- Leg swelling
- Assess prostate by DRE (males)
What investigations would one request for in a patient presenting with haematuria?
- Radiology: ultrasound, CT
- Endoscopy: flexible cystoscopy
- Urine: culture & sensitivity, cytology
- Bloods: FBC, U&E
What is Renal Cell Carcinoma?
RCC is a malignant tumour arising from the renal cells in the parenchyma of the kidney
How does RCC present?
- Haematuria
- Incidental finding (on imaging)
- A palpable mass (rare)
How does RCC present if advanced?
- Large varicocele
- Pulmonary/tumour embolus
- Loss of weight/appetite (metastasis)
- Hypercalcaemia
What are the risk factors for RCC?
- Smoking (2x↑)
- Obesity
- Dialysis
Identify the three ways in which RCC can spread

How can localised RCC be treated?
- Surveillance
- Excision: radical nephrectomy / partial nephrectomy
- Ablation: cryoablation / radiofrequency ablation
What does a radical nephrectomy involved?
Radical nephrectomy – removal of kidney, adrenal, surrounding fat, upper ureter
How can metastatic RCC be treated?
- Cannot be cured
- Palliative treatment – biological therapies (targeted)
What is clear renal cell carcinoma?
- CCRCC is a renal cortical tumour typically characterised by malignant epithelial cells
- The proximal convoluted tubule gives rise to this tumour
What is a Bladder Transitional Cell Carcinoma?
- TCC of the bladder is a malignant tumour arising from the transitional epithelial cells lining the bladder
- It is the most common primary neoplasm of the urinary bladder and the entire urinary system
How does TCC present?
- Haematuria
- Incidental finding (imaging)
How does TCC present, if advanced?
- Loss of weight/appetite (metastasis)
- DVT
- Lymphoedema
What are the risk factors for bladder TCC?
- Smoking (4x↑)
- Occupational exposure: rubber, plastics, handling of carbon, crude oil, combustion e.g. painters, mechanics, printers, hairdressers
Describe five features seen in the urine cytology of a patient with bladder cancer
- Clusters of neoplastic cells
- High nuclear:cytoplasmic ratio
- Nuclear hyperchromasia
- Pleomorphism
- Coarse nuclear chromatin

What is the initial management of bladder TCC?
Transurethral removal of bladder tumour
Outline the treatment plan of muscle invasive bladder TCC

What is a squamous cell carcinoma of the bladder?
A squamous cell carcinoma of the bladder is a rare malignant neoplasm derived from bladder urothelium with pure squamous phenotype
Which conditions in a patient’s history would cause one to consider the possibility of a squamous cell carcinoma of the bladder?
Schistosomiasis – parasitic infection of the urinary tract/intestines by shistosomes (parasitic flatworms)
What is a Renal Transitional Cell Carcinoma?
Renal TCC is a malignant tumour arising from the transitional epithelial cells lining the urinary tract from the renal calyces to the ureteral orifice

