Surgical Aspects of urological cancer Flashcards

1
Q

RF of renal cell cancer

A
  • renal failure and dialysis
  • men>women
  • smoking
  • hypertension
  • obesity
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2
Q

Genetic factors of renal cell cancer

A
  • VHL syndrome (von Hippel Lindau, 50% develop RCC)
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3
Q

5 histological subtypes of renal tumours

A
  • clear cell carcinoma (VHL mutation)
  • papillary type 1 and 2
  • chromophobe
  • collecting duct (rare)
  • medullary cell (rare)
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4
Q

Clinical Presentation of renal cell cancer

A
  • 50% asymptomatic
  • CLASSIC TRIAD = macroscopic haematuria, palpable mass, flank pain <10%
  • haematuria
  • flank pain
  • mass
  • signs of metastases = bone pain, anorexia, pyrexia of unknown origin
  • acute varicocele
  • lower limb oedema
  • paraneoplastic syndromes
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5
Q

Investigations for renal cell cancer

A
  • US
  • CT of abdomen with contrast
  • CT chest
  • bone scan
  • US renal tract
  • Bloods = FBC, U&E, calcium, LFT
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6
Q

Management of renal cell cancer

A

LOCALISED
- radical or partial nephrectomy (open or laparoscopic)
LOCALLY ADVANCED
- radial nephrectomy & adjuvant treatment
METASTATIC
- immunotherapy

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7
Q

Prognosis of renal cell cancer

A

depends on staging

  • T1 organ confined = 70-94%
  • T2 organ confined = 65-75%
  • T3 locally advanced = 40-70%
  • N1 = 40-70%
  • locally advanced T4, N2 or M1 = 10-40%
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8
Q

Bladder cancer RF

A
  • men>women
  • age
  • smoking
  • occupation (rubber, paint, dye manufacture)
  • chronic inflammation of bladder mucosa
  • schistosomiasis (squamous cell carcinoma)
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9
Q

Malignant bladder tumours

A
  • transitional cell carcinoma (90%)
  • squamous cell carcinoma (1-7%)
  • adenocarcinoma (2%)
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10
Q

Clinical Presentation of bladder cancer

A
  • painless macroscopic haematuria
  • microscopic haematuria
  • LUTS
  • Recurrent UTIs
  • Pain
  • lower limb swelling
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11
Q

Investigations for haematuria

A

Need to investigate persistent microscopic haematuria (2/3 dipstick) or macroscopic haematuria

  • IV urogram
  • renal function, urine microscopy and culture
  • glomerulonephritis screen?
  • US renal tract
  • flexible cystoscopy
  • urine cytology
  • CT urogram
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12
Q

Types of bladder cancer

A
  • papillary (70%)
  • mixed papillary and solid (10%)
  • solid (10%)
  • carcinoma in sit (10%)
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13
Q

Staging of bladder cancer

A
  • CXR
  • bone scan
  • CT/MRI of pelvis
  • TURBT (histology following transurethral resection of bladder tumour)
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14
Q

Management of bladder cancer

A
  • initial TURBT (70% curative)

- adjuvant treatment (MMC = intravesical mitomycin C, intravesical BCG)

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15
Q

Intravesical BCG

A
  • bladder cancer
  • adjuvant treatment
  • stimulates immune system in bladder wall to attack cancer cells
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16
Q

MMC

A
  • intravesical mitomycin C
  • reduces recurrent rate
  • prevents implantation
  • cytotoxic and regress small tumours
17
Q

Muscle Invasive TCC

A
  • radical cystectomy + urinary diversion
  • radical external beam radiotherapy
  • metastatic disease = chemo, radiotherapy
18
Q

Prostate cancer RF

A
  • high fat diets
  • smoking
  • most commonly diagnosed male cancer
19
Q

Types of prostate cancer

A
  • adenocarcinoma 95%(peripheral zone>, also can be in transitional or central)
  • prostatic sarcoma (rare)
20
Q

Presentation of prostate cancer

A
  • majority asymptomatic (PSA testing)
  • LUTS
  • haematospermia/haematuria
  • perineal discomfort
  • lower limb swelling
  • anorexia and weight loss
  • bone pain/pathological fractures
21
Q

PSA

A
  • glycoprotein enzyme produced by prostatic epithelial cells
  • function unclear
  • normal range varies with age <4ng/ml normally
22
Q

Increased PSA causes

A
  • BPH
  • prostatitis
  • DRE
  • urethral catheterisation
  • UTI
  • prostatic biopsy
23
Q

Investigations for prostate cancer

A
  • transrectal US guided biopsy

- gleason score

24
Q

Gleason Score

A
  • grade 1-5 according to gland forming differentiation
  • most multi focal and heterogenous
  • well diff = 2-4
  • mod diff = 5-7
  • poorly diff = 8-10
25
Management of localised prostate cancer
- radical prostatectomy = open, laparoscopic, robot-assisted laparoscopic - radical external beam radiotherapy - brachytherapy (implanting radioactive seeds into prostate) - cryotherapy
26
Management of advanced prostate cancer
Androgen deprivation therapy - surgical castration (bilateral orchidectomy) - medical castration (LH-RH agonist -> goserelin) - anti-androgen monotherapy
27
Testicular Cancer RF
- Caucasian > - un-descended testes - HIV infection - 1st degree relative
28
Types of testicular cancer
- germ cell tumours (seminoma, non-seminoma) - non germ cell tumours (sex cord stromal tumours -> Leydig, Sertoli) - lymphoma - adenomatoid
29
Presentation of testicular cancer
- painless scrotal lump - acute scrotal pain (intra-tumoural haemorrhage) - metastases = weight loss, lymphadenopathy, bone pain
30
Investigations for testicular cancer
- US (hypoechoic region distorting normal architecture, microlithiasis) - CT abdomen and chest (staging) - serum tumour markers (AFP, B-HCG, LDH)
31
Staging of testicular cancer
TNM - tumour stage Tx-T4 - nodes Nx-N3 - metastasis Mx-M1
32
Management of NSGST
Non metastatic disease - surveillance - adjuvant chemotherapy if RF relapse (T2-T4, lymphatic or vascular invasion) Metastatic disease - chemo (bleomycin, etoposide, cisplatin)
33
Management of SGST
Non metastatic disease - para aortic nodal spread risk - adjuvant = chemo, radio Metastatic - radio or chemo - retroperitoneal lymph node dissection