Session 11: Urological Cancers - RCC and TCC Flashcards
Types of urological cancers.
TCC (Transitional cell carcinoma)
RCC (Renal cell carcinoma)
Where in the UT do RCCs occur?
In the kidney
Where in the UT do TCCs occur?
Where ever.
Calyces, ureter, bladder or urethra.
How do RCCs present.
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
How do TCCs present?
Haematuria
May be found incidentally on imaging
If advanced may cause DVT, lymphoedema, weight loss, anorexia, malaise.
Classifications of haematuria
Visible or non-visible.
How can non-visible haematuria be classified?
As dipstick or microscopic
Symptomatic or asymptomatic
Dx of haematuria
Urological like cancer (RCC, TCC, upper UT TCC, advanced prostate carcinoma)
Stones
Infection
Inflammation
BPH
Nephrological glomerular inflammation like nephritic syndrome
History taken from patients with haematuria
Smoking
Occupation
Painful or painless
Other lower urinary tract symptoms
Family history
Examinations of patients with haematuria
BP
Abdo mass
Varicocoeles
Leg oedema
Assessment of prostate by DRE
Investigations of haematuria
Radiology USS and if needed also CT
Endoscopy
Urine culture and cytology
Bloods like FBC and U&E
Epidemiology of RCC
95% of all upper UT tumours
7th most common cancer in UK
Incidence and mortality is increasing
Risk factors of RCC
M:F 3:2
White > non-white
Smoking
Obesity
Dialysis
Spread of RCCs
Perinephric spread
Lymph node metastases (renal hilar or para-aortic)
IVC spread to right atrium from renal vein
Radiology of RCC
Ultrasound and CT for staging
Localised RCC treatment.
Surveillance
Surgery such as radical nephrectomy or partial nephrectomy
Ablation
Treatment of metastatic RCC.
Palliative with targeted therapies like angiogenesis.
Metastatic RCCs are chemo and radio resistant
What are 90% of bladder cancers?
TCCs
Epidemiology of bladder TCC
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
Risk factors of bladder TCC
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
Initial definitive treatment of bladder TCC
TUR bladder tumour (TURBT) where there is single intravesical instillation of mitomycin
Staging of bladder TCC.
Histological grading of TCC.
Treatment of high risk non muscle invasive TCC
Check cytoscopies and intravesical immunotherapy
Treatment of lower risk non muscle invasive TCC
Check cytoscopies +/- intravesical chemotherapy
Treatment of muscle-invasive TCC
Depends on whether it is deemed potentially curative or not curative
Treatment of potentially curative muscle invasive bladder TCC
Radical cystectomy or radiotherapy +/- chemotherapy
Treatment of non-curvative muscle invasive TCC
Palliative care
Chemoradiation
Give examples of radical cystectomy for bladder TCC
Ileal conduit or reconstruction e.g. Orthotopic one.
Indiana bladder
Percentage of upper urinary tract tumours that are TCCs
5%
Aetiology of Upper UT TCCs
Smoking
Phenacetin abuse
Balkan’s nephropathy
Initial investigation suspecting upper UT TCC.
Ultrasound for hydronephrosis
CT urogram to check filling defect or ureteric stricture
Retrograde pyelogram
Utereroscopy
Standard treatment of upper UT TCC.
Nephro-ureterectomy removing kidney, fat, ureter and cuff of bladder.
Treatment of metastatic TCC of bladder or upper urinary tract.
Systemic chemotherapy
Immunotherapy
What might a tumour located at the vesicoureteric juntion result in?
Ureteral obstruction, hydronephrosis and flank pain
What might a tumour near the urethral orifice result in?
Bladder outlet obstruction and urinary retention
