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Urinary > Session 11 > Flashcards

Session 11 Flashcards

1
Q

Types of urinary cancer

A

Renal cell carcinoma RCC (presents in parenchyma of kidney)

Transitional cell carcinoma TCC (from calyx to the bladder)

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2
Q

Renal cell carcinoma is in parenchyma of kidney which originates from

A

Metanephric blastema

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3
Q

Presentation of renal cell carcinoma

A

90% with haematuria or Incidental

Fatigue, weight loss, fever, mass in loin

Often metastasise before local symptoms develop

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4
Q

Features of advanced RCC

A

Small number can secrete hormone like substances such a PTH-rP (present with hypercalcemia)

Large varicocele may be present

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5
Q

Why might a varicocele be present in RCC

A

Compression of left gonadal vein
Not on right side as straight to IVC

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6
Q

Occurrence of RCC

A

90% of renal malignant tumours in adults are RCCs

Arise from tubular epithelium

Rare in children, peak incidence in 60-70 year olds

Male:female 3:1

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7
Q

Risk factors for RCC

A

Dialysis
Smoking
Obesity

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8
Q

Staging of RCC

A
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9
Q

Investigations RCC

A

Radiology- USS or CT

Endoscopy- flexible cystoscopy

Urine- cystology

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10
Q

Treatment for localised RCC

A

Surveillance

Small tumours removed with partial nephrectomy to preserve some renal function

Radical nephrectomy with removal of adrenal gland, perinephric fat, upper ureter and para-aortic lymph nodes if large tumour

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11
Q

Treatment of metastatic RCC

A

Little effective treatment for metastatic disease

Chemo and radiotherapy

Palliative treatment- target angiogenesis

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12
Q

Presentation of transitional cell carcinoma

A

Haematuria
Incidental finding on imaging (USS or CT)
Weight loss, anorexia
Signs/symptoms of obstruction

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13
Q

70 y old man with haematuria differentials

A

Bladder cancer
Bleeding from the prostate (benign or malignant)
RCC
UTI
Nephritic conditions
Polycystic kidney disease

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14
Q

Staging of bladder TCC

A

75% superficial, 5% Tis/carcinoma in situ/flat tumour, 20% are muscle-invasive, tumours are graded

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15
Q

Questions to ask someone presenting with haematuria

A

Amount of bleeding, where in stream
Type of blood
Urinary symptoms
Medical problems
Occupation
Lifestyle
Weight loss

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16
Q

Diagnosis of someone presenting with haematuria with potential TCC

A

Cystoscopy and biopsy

Cytological examination of urine to check for malignant cells and cystoscopy of lower urinary tract

17
Q

Epidemiology bladder TCC

A

Male:female 3:1

Caused by:
Analgesic misuse, exposure to aniline dyes used in industry, smoking

18
Q

Diagnosis of TCC

A

CT scan
MRI scan
CXR
Cystoscopy or ureteroscopy

19
Q

Treatment of someone with TCC

A

Low risk non-muscle invasive- TURBT +/- intravesical chemotherapy

High risk non-muscle invasive- TURBT + intravesical chemotherapy, intravesical BCG treatment, cystectomy

Muscle invasive cancer- cystectomy + radiotherapy (with radiosensitiser) or palliative care

20
Q

What is cystectomy

A

Stoma outside body, conduit inside body, Bladder removed

21
Q

Investigations for TCC

A

Urine dipstick to exclude UTI
Cystology
Urine culture or sensitivity
FBC
U&Es
Biochemical profile
Ultrasound
Ct urogram
Flexible cystoscopy

22
Q

Why would you do a biochemical profile in TCC investigations

A

Evidence of bone or liver metastases, X ray kidneys ureter and bladder

23
Q

Why ultrasound in TCC management

A

Renal cancer, hydronephrosis, check state of bladder

24
Q

Why CT urogram in TCC management

A

Function and anatomy of urinary tracts

25
Q

Management for TCC

A

Referred to urologist, grade and stage

Transurethral resection of tumour if low grade non-muscle invasive bladder cancer

Single instillation of a chemotherapeutic agent significantly reduces incidence of recurrent disease

Patient will need follow up surveillance with cystoscopy

26
Q

Definitive diagnosis of bladder cancer made on

A

Biopsy

27
Q

Most important prognostic factor of bladder cancer

A

Bladder muscle invasion

28
Q

TCC of upper urinary tract stats

A

5% of all malignancies affects upper urinary tract

40% chance of developing bladder cancer (seeding)

29
Q

Presentation of TCC of upper urinary Tract

A

Presentation with haematuria or obstruction occurs early as renal pelvis projects directly into pelvicalyceal cavity

30
Q

Treatment of TCC of upper urinary Tracy

A

Nephro-ureterectomy (kidney, fat, ureter, cuff of bladder)

Urinary (20 decks)

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