Tumours Flashcards
List the main benign renal tumours
Fibroma
Adenoma
Angiomyolipoma
Juxtaglomerular cell tumour (JGCT)
Which area of the kidney do fibromas originate from?
Medulla
Which area of the kidney do adenomas originate from?
Cortex
Which condition is associated with angiomyolipoma?
Tuberous sclerosis
JGCT can cause primary hypertension. True/False?
False
Secondary hypertension; secrete renin
List the main malignant renal tumours
Nephroblastoma
Urothelial carcinoma
Renal cell carcinoma
Which malignant renal tumour is commonest in children and adults?
Nephroblastoma in children
Renal cell carcinoma in adults
Where do nephroblastoma arise from?
Residual primitive renal tissue
Where do renal cell carcinoma arise from?
Renal tubular epithelium
List clinical features of renal cell carcinoma
Abdominal mass Haematuria Flank pain Hypercalcaemia Polycythemia (raised RBC)
Renal vein extension is common in renal cell carcinoma. True/False?
True
Can extend into vena cava and right atrium
Which type of renal cell carcinoma is the most common?
Clear cell type - rich in glycogen and lipid
Which malignant tumour affects the area between the pelvicalyceal system to the urethra?
Transitional cell carcinoma (of transitional epithelium)
List risk factors for transitional cell carcinoma
Dyes
Rubber industry
Cyclophosphamide
Smoking
Where do 75% of transitional cell carcinomas occur?
Region of trigone, leading to ureteric obstruction
What is the main tumour that affects the penis?
Squamous cell carcinoma in situ
Which group of individuals are particularly susceptible to squamous cell carcinoma of the penis?
Uncircumcised men
Also note poor hygiene + HPV infection
What occupation was linked with SCC of the scrotum?
Chimney sweeps
At least 75% of men over 70 are affected by benign nodular hyperplasia of prostate. True/False?
True
What is the proposed aetiology behind benign nodular hyperplasia of prostate (BNH)?
Hormone imbalance - androgen decreases as get older but oestrogen level remains same; gland is oestrogen responsive
List clinical features of BNH of prostate and general prostatism
Difficulty in starting micturition
Poor stream
Overflow incontinence
How is BNH of prostate managed?
Surgery - transurethral resection
Drugs - alpha blocker, 5-alpha-reductase inhibitor
BNH of prostate is pre-malignant. True/False?
False
Carcinoma of prostate is associated with BNH of prostate. True/False?
False
Not associated but both can occur at once
Why do symptoms of carcinoma of prostate only arise when the disease is more advanced?
Carcinoma arises in peripheral ducts and glands, so peri-urethral (bladder obstructive) area is involved at later stage
What effect can prostate carcinoma have on bone?
Osteosclerotic metastases
List investigations for prostate carcinoma
PR exam
Ultrasound/XR
Prostate Specific Antigen (PSA)
Biopsy
List management for prostate carcinoma
Anti-androgen drug
Radiotherapy if bone metastases
Surgery (prostatectomy)
State a major risk factor for developing testicular tumour
Testicular maldescent
How do testicular tumours usually present?
Painless testicular enlargement
Name the most common class of testicular tumour
Germ cell tumour (seminoma, teratoma)
What is the commonest germ cell tumour?
Seminoma
Seminomas are very rare before puberty. True/False?
True
Which tumour marker is useful for identifying seminoma?
Placental alkaline phosphatase (PLAP)
List the zonal anatomy of the prostate in order of most-least % origin of prostate cancer
Peripheral (70%)
Transitional (20%)
Central (5%)
Which zone of the prostate gives rise to benign prostate hyperplasia?
Transitional zone
List abnormal findings of a digital rectal exam that could indicate prostate cancer
Asymmetry
Nodule
Hard, craggy mass
Which marker is usually used to detect prostatic disease?
PSA (prostate specific antigen)
Where is PSA produced?
Enzyme produced by secretory epithelial cells of prostate gland, involved in liquefying semen
In healthy people serum PSA is high. True/False?
False
Semen levels of PSA are high but serum is normal in normal people
High PSA in serum suggests cancer
Is specificity of PSA for cancer high or low?
Low (40%)
Can be raised in prostatitis, UTI, catheterisation
How is a biopsy of prostate cancer taken?
Trans-rectal ultrasound-guided approach 10 biopsies (5 from each lobe) taken
What is the majority of prostate cancer?
Multifocal adenocarcinoma
What are the most common sites for prostate adenocarcinoma metastasis?
Pelvic lymph nodes
Skeleton (osteosclerosis)
Which score is used to grade prostate malignancy?
Gleason score
Also use bone scan/MRI/CT
Outline management of organ-confined prostate cancer
Watchful waiting/symptom-guided
Active monitoring
Outline management of locally-advanced prostate cancer
Radiotherapy + hormonal therapy
Outline management of metastatic prostate cancer
Androgen-deprivation therapy
Steroids
Cytotoxic chemotherapy
How do LHRH agonists provide hormonal therapy in prostate cancer?
Stimulate pituitary to increase LH/FSH which increases testosterone
What is the majority of urothelial tumours?
Transitional cell carcinoma
Most transitional cell carcinoma is papillary. True/False?
True
20% non-papillary