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US > Session 11: Urological Cancers - RCC and TCC > Flashcards

Session 11: Urological Cancers - RCC and TCC Flashcards

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1
Q

Types of urological cancers.

A

TCC (Transitional cell carcinoma)

RCC (Renal cell carcinoma)

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2
Q

Where in the UT do RCCs occur?

A

In the kidney

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3
Q

Where in the UT do TCCs occur?

A

Where ever.

Calyces, ureter, bladder or urethra.

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4
Q

How do RCCs present.

A

Haematuria and usually incidental finding on imaging.

If it is advanced it may cause large varicoeles, pulmonary/tumour embolus, loss of weight, anorexia, malaise.

Hypercalcaemia

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5
Q

How do TCCs present?

A

Haematuria

May be found incidentally on imaging

If advanced may cause DVT, lymphoedema, weight loss, anorexia, malaise.

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6
Q

Classifications of haematuria

A

Visible or non-visible.

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7
Q

How can non-visible haematuria be classified?

A

As dipstick or microscopic

Symptomatic or asymptomatic

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8
Q

Dx of haematuria

A

Urological like cancer (RCC, TCC, upper UT TCC, advanced prostate carcinoma)

Stones

Infection

Inflammation

BPH

Nephrological glomerular inflammation like nephritic syndrome

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9
Q

History taken from patients with haematuria

A

Smoking

Occupation

Painful or painless

Other lower urinary tract symptoms

Family history

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10
Q

Examinations of patients with haematuria

A

BP

Abdo mass

Varicocoeles

Leg oedema

Assessment of prostate by DRE

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11
Q

Investigations of haematuria

A

Radiology USS and if needed also CT

Endoscopy

Urine culture and cytology

Bloods like FBC and U&E

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12
Q

Epidemiology of RCC

A

95% of all upper UT tumours

7th most common cancer in UK

Incidence and mortality is increasing

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13
Q

Risk factors of RCC

A

M:F 3:2

White > non-white

Smoking

Obesity

Dialysis

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14
Q

Spread of RCCs

A

Perinephric spread

Lymph node metastases (renal hilar or para-aortic)

IVC spread to right atrium from renal vein

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15
Q

Radiology of RCC

A

Ultrasound and CT for staging

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16
Q

Localised RCC treatment.

A

Surveillance

Surgery such as radical nephrectomy or partial nephrectomy

Ablation

17
Q

Treatment of metastatic RCC.

A

Palliative with targeted therapies like angiogenesis.

Metastatic RCCs are chemo and radio resistant

18
Q

What are 90% of bladder cancers?

A

TCCs

19
Q

Epidemiology of bladder TCC

A

8th most common cancer in men

14th in women

Incidence decreasing but presentation is more advanced in women

M:F 3:1

White > non-white

20
Q

Risk factors of bladder TCC

A

Smoking (4x)

Occupational exposure such as rubber or plastics (arylamines), polyaromatic hydrocarbons such as carbon, crude oil, combustion and smelting.

Painters, mechanics, printers and hairdressers

21
Q

Initial definitive treatment of bladder TCC

A

TUR bladder tumour (TURBT) where there is single intravesical instillation of mitomycin

22
Q

Staging of bladder TCC.

A
23
Q

Histological grading of TCC.

A
24
Q

Treatment of high risk non muscle invasive TCC

A

Check cytoscopies and intravesical immunotherapy

25
Q

Treatment of lower risk non muscle invasive TCC

A

Check cytoscopies +/- intravesical chemotherapy

26
Q

Treatment of muscle-invasive TCC

A

Depends on whether it is deemed potentially curative or not curative

27
Q

Treatment of potentially curative muscle invasive bladder TCC

A

Radical cystectomy or radiotherapy +/- chemotherapy

28
Q

Treatment of non-curvative muscle invasive TCC

A

Palliative care

Chemoradiation

29
Q

Give examples of radical cystectomy for bladder TCC

A

Ileal conduit or reconstruction e.g. Orthotopic one.

Indiana bladder

30
Q

Percentage of upper urinary tract tumours that are TCCs

A

5%

31
Q

Aetiology of Upper UT TCCs

A

Smoking

Phenacetin abuse

Balkan’s nephropathy

32
Q

Initial investigation suspecting upper UT TCC.

A

Ultrasound for hydronephrosis

CT urogram to check filling defect or ureteric stricture

Retrograde pyelogram

Utereroscopy

33
Q

Standard treatment of upper UT TCC.

A

Nephro-ureterectomy removing kidney, fat, ureter and cuff of bladder.

34
Q

Treatment of metastatic TCC of bladder or upper urinary tract.

A

Systemic chemotherapy

Immunotherapy

35
Q

What might a tumour located at the vesicoureteric juntion result in?

A

Ureteral obstruction, hydronephrosis and flank pain

36
Q

What might a tumour near the urethral orifice result in?

A

Bladder outlet obstruction and urinary retention

37
Q
A

US (29 decks)

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