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Year 3 - Met3b > Surgical aspects of urological cancer > Flashcards

Surgical aspects of urological cancer Flashcards

1
Q

What are the risk factors of renal cell cancer

A
  • Male>Female (x1.5)
  • Smoking (x1.4-2.3)
  • Renal failure and dialysis (x30)
  • Von-Hippel Lindau (~50% develop RCC)
  • Age 60-80
  • polycystic and horseshoe kidney
  • hypertension (x1.4-2)
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2
Q

How many cases per year are there of renal cell cancer

A

7000 cases per annum

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3
Q

What are the histological cell types of renal cell cancer

A
  • Clear cell carcinoma (80%) – VHL mutation seen
  • Papillary type 1 and 2 (10-15%)
  • Chromophobe (5%)
  • Rare forms - Collecting Duct / Medullary cell
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4
Q

What are the symptoms and signs of renal cell cancer

A
  • 50% asymptomatic (incidental finding)
  • Classic triad – loin pain, haematuria, loin mass
    Loin mass (40%)
  • Renal angle pain
  • Haematuria (50%)
  • Lower limb oedema
  • Metastatic disease at presentation (25%)
  • Left varicocoele
  • Weight loss/ fevers/night sweats
  • Can also present with ectopic hormone productions: epo, renin, PTH
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5
Q

What are the investigation of renal cell cancer

A
  • FBC - anaemia or polycythaemia
  • U and E
  • calcium
  • USS
  • CT and bone scan for staging
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6
Q

What is the management for renal cell cancer

A
  • Radical or partial nephrectomy (open or laparoscopic)
  • Adjuvant chemotherapy
  • Immunotherapy - tyrosine kinase inhibitors
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7
Q

What is the prognosis for renal cell cancer

A
  • Organ-confined T1: 70-94%
  • Organ-confined T2: 65-75%
  • Locally advanced T3: 40-70%
  • Locally advanced T4: 10-40%
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8
Q

What are the risk factors for bladder cancer

A
  • Male>Female (x2.5)
  • Age 60-80
  • Smoking (x2-5)
  • Aniline dyes (rubber/paint/dye manufacturing)
  • Cyclophosphamide therapy
  • Chronic inflammation (schistosomiasis, infection, long term catheter)
  • Pelvic radiotherapy
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9
Q

What is the histology of bladder cancer

A
  • Usually Transitional Cell Carcinoma
  • Squamous Cell Carcinoma in schistosomiasis
  • Adenocarcinoma (rare)
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10
Q

What are the symptoms and signs of bladder cancer

A
  • Painless macroscopic haematuria – age >50 – one third will have bladder ca
  • Microscopic haematuria – age > 50 – 7-13% will have bladder ca
  • Lower Urinary Tract Symptoms (LUTS)
  • Recurrent UTIs
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11
Q

What are the investigations of bladder cancer

A

Persistent microscopic haematuria (2 out of 3 tests +ve) or macroscopic haematuria must be investigated:
U&E, Urine MC&S, CT urogram, USS renal tract, Urinary cytology, Flexible cystoscopy

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12
Q

What is staging of bladder cancer based on

A

Histology following transurethral resection of bladder tumour (TURBT):

  • Superficial / Muscle invasive
  • CT or MRI of pelvis + Chest x-ray + Bone scan
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13
Q

How do you manage bladder cancer

A
  • TURBT – curative in 70%
  • Adjuvant chemo - Mitomycin C, Intravesical BCG
  • Radical cystectomy + urinary diversion
  • Radiotherapy
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14
Q

How many people per year experience bladder cancer

A

11,000 cases per annum

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15
Q

What are the risk factors for prostate cancer

A
  • age
  • afro-caribbean
  • smoking
  • high fat diet
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16
Q

How many people a year get prostate cancer

A

32,000 per annum

17
Q

What is the histology of prostate cancer

A 
Adenocarcinoma - 95% (Zones - Peripheral (75%), Transition (20%), Central (5%))
Prostatic sarcomas (5%)
18
Q

What are the signs and symptoms of prostate cancer

A
  • Majority asymptomatic
  • LUTS
  • Back pain
  • Perineal pain
  • Haematuria / Haematospermia
  • Anorexia / Weight loss
  • Nodular prostate on DRE
19
Q

How do you investigate Prostate cancer

A

Prostate Specific Antigen: Glycoprotein enzyme produced by prostatic epithelial cells. Function unclear. Normal range varies with age, but generally <4 ng/ml

Transrectal ultrasound (TRUS) and biopsy.

20
Q

Name other causes of increased PSA

A
  • benign prostatic hypertrophy (BPH)
  • prostatitis
  • digital rectal examination (DRE)
  • urethral catheterisation
  • urinary tract infection (UTI)
  • prostatic biopsy
21
Q

How is prostate cancer graded

A

Gleason grading system

22
Q

Describe how prostate is graded

A

Gleason score is a score of the most common histological pattern seen + the highest grade of tumour histology seen:

  • Well differentiated: Score 2-4
  • Moderately differentiated: Score 5-7
  • Poorly differentiated: Score 8-10
23
Q

How do you manage prostate cancer

A
  • Radical prostatectomy: Open/Laparoscopic/Robot-assisted
  • Radical external beam radiotherapy
  • Brachytherapy - iImplanting radioactive seeds into prostate - Cryotherapy

Androgen deprivation therapy:

  • Surgical castration – bilateral orchidectomy
  • Medical castration – LH-RH agonist e.g. Goserelin (Zoladex)
  • Anti-androgen monotherapy
24
Q

What is the risk factors for testicular cancer

A
  • Un-descended testes: increases risk x 3-14
  • HIV infection
  • First degree relative
  • White caucasian - x3-4 risk of afro-caribbean)

Age

  • 20-35 teratoma
  • 35-45 - seminoma
  • greater than 60 lymphoma
25
Q

How many people develop testicular cancer

A

6/100000

26
Q

What is the histology for testicular cancer

A
  • Germ cell tumours - 90%
  • seminoma (SGCT) and non seminoma (NSGCT)
  • Non germ cell - sex cord stromal tumours (3%) (ledwig/sertoli cell)
  • other tumours (7% ) - lymhoma, adenomatoid
27
Q

what are the symptoms and signs of testicular cancer

A
  • painless testicular mass
  • testicular pain (5%)
  • haematospermia
28
Q

What are the investigations for testicular cancer

A
  • Tumour markers - Alpha-fetoprotein, B-HCG, LDH
  • USS testis
  • CT for staging
29
Q

What is the management for testicular cancer

A
  • Orchidectomy

- adjuvant chemotherapy

Year 3 - Met3b (26 decks)

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