Session 11 Flashcards
Types of urinary cancer
Renal cell carcinoma RCC (presents in parenchyma of kidney)
Transitional cell carcinoma TCC (from calyx to the bladder)
Renal cell carcinoma is in parenchyma of kidney which originates from
Metanephric blastema
Presentation of renal cell carcinoma
90% with haematuria or Incidental
Fatigue, weight loss, fever, mass in loin
Often metastasise before local symptoms develop
Features of advanced RCC
Small number can secrete hormone like substances such a PTH-rP (present with hypercalcemia)
Large varicocele may be present
Why might a varicocele be present in RCC
Compression of left gonadal vein
Not on right side as straight to IVC
Occurrence of RCC
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
Risk factors for RCC
Dialysis
Smoking
Obesity
Staging of RCC
Investigations RCC
Radiology- USS or CT
Endoscopy- flexible cystoscopy
Urine- cystology
Treatment for localised RCC
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
Treatment of metastatic RCC
Little effective treatment for metastatic disease
Chemo and radiotherapy
Palliative treatment- target angiogenesis
Presentation of transitional cell carcinoma
Haematuria
Incidental finding on imaging (USS or CT)
Weight loss, anorexia
Signs/symptoms of obstruction
70 y old man with haematuria differentials
Bladder cancer
Bleeding from the prostate (benign or malignant)
RCC
UTI
Nephritic conditions
Polycystic kidney disease
Staging of bladder TCC
75% superficial, 5% Tis/carcinoma in situ/flat tumour, 20% are muscle-invasive, tumours are graded
Questions to ask someone presenting with haematuria
Amount of bleeding, where in stream
Type of blood
Urinary symptoms
Medical problems
Occupation
Lifestyle
Weight loss
Diagnosis of someone presenting with haematuria with potential TCC
Cystoscopy and biopsy
Cytological examination of urine to check for malignant cells and cystoscopy of lower urinary tract
Epidemiology bladder TCC
Male:female 3:1
Caused by:
Analgesic misuse, exposure to aniline dyes used in industry, smoking
Diagnosis of TCC
CT scan
MRI scan
CXR
Cystoscopy or ureteroscopy
Treatment of someone with TCC
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
What is cystectomy
Stoma outside body, conduit inside body, Bladder removed
Investigations for TCC
Urine dipstick to exclude UTI
Cystology
Urine culture or sensitivity
FBC
U&Es
Biochemical profile
Ultrasound
Ct urogram
Flexible cystoscopy
Why would you do a biochemical profile in TCC investigations
Evidence of bone or liver metastases, X ray kidneys ureter and bladder
Why ultrasound in TCC management
Renal cancer, hydronephrosis, check state of bladder
Why CT urogram in TCC management
Function and anatomy of urinary tracts
Management for TCC
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
Definitive diagnosis of bladder cancer made on
Biopsy
Most important prognostic factor of bladder cancer
Bladder muscle invasion
TCC of upper urinary tract stats
5% of all malignancies affects upper urinary tract
40% chance of developing bladder cancer (seeding)
Presentation of TCC of upper urinary Tract
Presentation with haematuria or obstruction occurs early as renal pelvis projects directly into pelvicalyceal cavity
Treatment of TCC of upper urinary Tracy
Nephro-ureterectomy (kidney, fat, ureter, cuff of bladder)
