Surgical aspects of urological cancer Flashcards
What are the risk factors of renal cell cancer
- 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)
How many cases per year are there of renal cell cancer
7000 cases per annum
What are the histological cell types of renal cell cancer
- Clear cell carcinoma (80%) – VHL mutation seen
- Papillary type 1 and 2 (10-15%)
- Chromophobe (5%)
- Rare forms - Collecting Duct / Medullary cell
What are the symptoms and signs of renal cell cancer
- 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
What are the investigation of renal cell cancer
- FBC - anaemia or polycythaemia
- U and E
- calcium
- USS
- CT and bone scan for staging
What is the management for renal cell cancer
- Radical or partial nephrectomy (open or laparoscopic)
- Adjuvant chemotherapy
- Immunotherapy - tyrosine kinase inhibitors
What is the prognosis for renal cell cancer
- Organ-confined T1: 70-94%
- Organ-confined T2: 65-75%
- Locally advanced T3: 40-70%
- Locally advanced T4: 10-40%
What are the risk factors for bladder cancer
- 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
What is the histology of bladder cancer
- Usually Transitional Cell Carcinoma
- Squamous Cell Carcinoma in schistosomiasis
- Adenocarcinoma (rare)
What are the symptoms and signs of bladder cancer
- 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
What are the investigations of bladder cancer
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
What is staging of bladder cancer based on
Histology following transurethral resection of bladder tumour (TURBT):
- Superficial / Muscle invasive
- CT or MRI of pelvis + Chest x-ray + Bone scan
How do you manage bladder cancer
- TURBT – curative in 70%
- Adjuvant chemo - Mitomycin C, Intravesical BCG
- Radical cystectomy + urinary diversion
- Radiotherapy
How many people per year experience bladder cancer
11,000 cases per annum
What are the risk factors for prostate cancer
- age
- afro-caribbean
- smoking
- high fat diet
How many people a year get prostate cancer
32,000 per annum
What is the histology of prostate cancer
Adenocarcinoma - 95% (Zones - Peripheral (75%), Transition (20%), Central (5%)) Prostatic sarcomas (5%)
What are the signs and symptoms of prostate cancer
- Majority asymptomatic
- LUTS
- Back pain
- Perineal pain
- Haematuria / Haematospermia
- Anorexia / Weight loss
- Nodular prostate on DRE
How do you investigate Prostate cancer
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.
Name other causes of increased PSA
- benign prostatic hypertrophy (BPH)
- prostatitis
- digital rectal examination (DRE)
- urethral catheterisation
- urinary tract infection (UTI)
- prostatic biopsy
How is prostate cancer graded
Gleason grading system
Describe how prostate is graded
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
How do you manage prostate cancer
- 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
What is the risk factors for testicular cancer
- 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
