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[AMS] Urinary System > S11) Urological Cancers > Flashcards

S11) Urological Cancers Flashcards

1
Q

How does one assess haematuria?

A
  • Visible changes
  • Non visible changes: microscopy & urine dipstick
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2
Q

What is the differential diagnosis of haematuria?

A
  • Urological

I. Cancer

II. Other – stones, infection, inflammation, BPH

  • Nephrological (glomerular)
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3
Q

Describe the key components of the history of a patient presenting with haematuria

A
  • Smoking
  • Occupation
  • Painful/painless
  • Other LUTS
  • Family history
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4
Q

How would one examine a patient presenting with haematuria?

A
  • BP
  • Abdominal mass
  • Varicocele
  • Leg swelling
  • Assess prostate by DRE (males)
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5
Q

What investigations would one request for in a patient presenting with haematuria?

A
  • Radiology: ultrasound, CT
  • Endoscopy: flexible cystoscopy
  • Urine: culture & sensitivity, cytology
  • Bloods: FBC, U&E
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6
Q

What is Renal Cell Carcinoma?

A

RCC is a malignant tumour arising from the renal cells in the parenchyma of the kidney

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7
Q

How does RCC present?

A
  • Haematuria
  • Incidental finding (on imaging)
  • A palpable mass (rare)
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8
Q

How does RCC present if advanced?

A
  • Large varicocele
  • Pulmonary/tumour embolus
  • Loss of weight/appetite (metastasis)
  • Hypercalcaemia
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9
Q

What are the risk factors for RCC?

A
  • Smoking (2x↑)
  • Obesity
  • Dialysis
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10
Q

Identify the three ways in which RCC can spread

A
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11
Q

How can localised RCC be treated?

A
  • Surveillance
  • Excision: radical nephrectomy / partial nephrectomy
  • Ablation: cryoablation / radiofrequency ablation
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12
Q

What does a radical nephrectomy involved?

A

Radical nephrectomy – removal of kidney, adrenal, surrounding fat, upper ureter

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13
Q

How can metastatic RCC be treated?

A
  • Cannot be cured
  • Palliative treatment – biological therapies (targeted)
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14
Q

What is clear renal cell carcinoma?

A
  • CCRCC is a renal cortical tumour typically characterised by malignant epithelial cells
  • The proximal convoluted tubule gives rise to this tumour
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15
Q

What is a Bladder Transitional Cell Carcinoma?

A
  • 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
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16
Q

How does TCC present?

A
  • Haematuria
  • Incidental finding (imaging)
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17
Q

How does TCC present, if advanced?

A
  • Loss of weight/appetite (metastasis)
  • DVT
  • Lymphoedema
18
Q

What are the risk factors for bladder TCC?

A
  • Smoking (4x↑)
  • Occupational exposure: rubber, plastics, handling of carbon, crude oil, combustion e.g. painters, mechanics, printers, hairdressers
19
Q

Describe five features seen in the urine cytology of a patient with bladder cancer

A
  • Clusters of neoplastic cells
  • High nuclear:cytoplasmic ratio
  • Nuclear hyperchromasia
  • Pleomorphism
  • Coarse nuclear chromatin
20
Q

What is the initial management of bladder TCC?

A

Transurethral removal of bladder tumour

21
Q

Outline the treatment plan of muscle invasive bladder TCC

A
22
Q

What is a squamous cell carcinoma of the bladder?

A

A squamous cell carcinoma of the bladder is a rare malignant neoplasm derived from bladder urothelium with pure squamous phenotype

23
Q

Which conditions in a patient’s history would cause one to consider the possibility of a squamous cell carcinoma of the bladder?

A

Schistosomiasis – parasitic infection of the urinary tract/intestines by shistosomes (parasitic flatworms)

24
Q

What is a Renal Transitional Cell Carcinoma?

A

Renal TCC is a malignant tumour arising from the transitional epithelial cells lining the urinary tract from the renal calyces to the ureteral orifice

25
Q

What are the risk factors for renal TCC?

A
  • Smoking
  • Phenacetin abuse
  • Balkan’s nephropathy
26
Q

What is the standard treatment of renal TCC?

A

Nephro-ureterectomy – kidney, fat, ureter, cuff of bladder

27
Q

What is the treatment for metastatic TCC (renal/bladder)?

A
  • Systemic chemotherapy
  • Biological therapies – immunotherapy
28
Q

What is prostate cancer?

A
  • Prostate cancer is the slow-growing development of cancer in the prostate gland of the male reproductive system
  • It commonly forms in the peripheral zone of the prostate but benign tumours also form in the transitional zone
29
Q

What are the risk factors for prostate cancer?

A
  • Age (increases)
  • Family history e.g. BRCA2 gene mutation
  • Ethnicity (Black > White > Asian)
30
Q

What does screening for prostate cancer involve?

A

PSA testing – prostate specific antigen blood test

31
Q

When should a doctor refer a patient for PSA screening?

A
  • When they present with associated symptoms
  • When they come to discuss a family member who has prostate cancer / because they have read about PSA
32
Q

What are the issues with PSA testing results?

A
  • You can’t rely on a PSA within 6 weeks of a urinary infection
  • Having a normal PSA does not mean you do not have prostate cancer
  • You can have a normal PSA but an abnormal feeling prostate on DRE
33
Q

State four other causes of raised PSA

A
  • Infection
  • Inflammation
  • Large prostate
  • Urinary retention
34
Q

How do patients with prostate cancer present?

A
  • Urinary symptoms
  • Bone pain
  • Abnormal DRE
  • Incidental finding (at transurethral resection of prostate)
35
Q

Outline the diagnostic pathway for prostate cancer

A
  • DRE + Serum PSA → transrectal ultrasound-guided biopsy of prostate
  • Lower urinary tract symptoms → transurethral resection of prostate (TURP)
36
Q

What are the 5 factors influencing treatment decisions for prostate cancer?

A
  • Age
  • DRE (localised, locally advanced, advanced)
  • PSA level
  • Biopsies (Gleason grade, extent)
  • MRI / bone scan (metastases)
37
Q

How is localised prostate cancer treated?

A
  • Surveillance
  • Robotic radical prostatectomy
  • Radiotherapy
38
Q

How is locally advanced prostate cancer treated?

A
  • Surveillance
  • Hormones
  • Hormones & radiotherapy
39
Q

Describe the treatement of metastatic prostate cancer

A
  • Hormones(± chemotherapy):

I. Surgical castration

II. Medical castration

  • Palliative care:

I. Single-dose radiotherapy

II. Chemotherapy

40
Q

Why is it possible to feel changes in the prostate during a digital rectal examination?

A
  • Tumour normally occurs in peripheral zone of prostate gland
  • Posterior side of the prostate is right next to the anterior wall of the rectum
41
Q

Why do patients with prostate cancer present with urinary symptoms?

What are these symptoms?

A

Tumour compresses the prostatic urethra, hence producing LUT symptoms:

  • Urinary retention
  • Urinary frequency
  • Dysuria
  • Nocturia
42
Q

Why do patients with prostate cancer present with lower back pain?

A
  • Bone metastases (main)
  • Lymphatic metastases to seminal vesicles (nerve compression)

[AMS] Urinary System (23 decks)

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