Tumours Flashcards
what type of cancer is renal cell carcinoma? where does it arise from?
adenocarcinoma of renal cortex which arises from the proximal convoluted tubule
risk factors renal cell carcinoma
smoking obesity HTN renal failure dialysis polycystic & horseshoe kidneys VHL (autosomal dom cond)
clinical features renal cell carcinoma
classic triad: (HiLF) haematuria loin pain a mass in the flank other features: malaise, weight loss, fever
renal cell carcinoma metastases?
25% have metastases at presentation to bone, liver and lung
investigations renal cell carcinoma
USS to distinguish benign cyst from tumour
CT / MRI more sensitive
Percutaneous biopsy. Bone scan if Ca raised
Management localised renal cell carcinoma
radical nephrectomy = preferred rx
partial nephrectomy if bilateral involvement or contralat kidney functions partly
what can be used for pts who wouldnt tolerate surgery
ablative techniques eg cryoablation or radiofrequency
Management metastatic/locally advanced renal cell carcinoma
interleukin-2 and interferon produce remission in 20% of cases
prognosis renal cell carcinoma
5 yr survival 60-70% with tumours confined to renal parenchyma but less than 5% in those with distant metastases
urothelial tumours affect what?
the calyces, renal pelvis, ureter, bladder and urethra are lines by transitional cell epithelium.
Bladder tumours are most common
epidemiology bladder transitional cell (urothelial) tumours
after 40y
4x more common in males
risk factors bladder cancer
cigarette smoking exposure to industrial chemicals eg ß-naphthylamine, benzidine exposure to drugs eg cyclophosphamide chronic inflammation eg schistomiasis FHx
what is schistomiasis
a parasite that causes chronic inflammation of the urinary tract = squamous cell carcinoma of the bladder
causes 50% of bladder cancers WW
clinical features bladder urothelial transitional cell carcinoma
painless haematuria
symptoms suggestive of a UTI (frequency, urgency, dysuria) in the absence of bacteriuria
pain is usually due to metastatic disease
transitional cell cancers of the kidney and ureters present with…
haematuria and flank pain
investigations urothelial tumours
haematuria of any pt over 40y should be assumed to have a urothelial tumour until proven otherwise dipstick bloods flexible cytoscopy upper tract imaging - CT/USS
management urothelial tumours
pelvic and ureteric tumours treated with nephroureterectomy
treatment bladder cancer depends on the stage - local diathermy or cystoscopic resection, TURBT, bladder resection, radiotherapy and local / systemic chemo
What is TURBT?
Transurethral resection of a bladder tumour
first line surgical rx for bladder tumours, like the cystoscope, the instrument used to remove the tumour is put in the bladder via the urethra - stage and grade
prostatic carcinoma - type of cancer?
adenocarcinoma
epidemiology prostatic carcinoma
common
malignant change within prostate is inc common with inc age - present in 80% of men age 80 and over - most cases remain dormant
clinical features prostatic carcinoma
screening for prostate cancer - serum PSA
bladder outflow obstruction
occasionally = symps of metastases to bone and nodes
diagnosis prostatic carcinoma
transrectal US of the prostate
elevated serum PSA
transrectal prostate biopsy
endorectal coil MRI to stage tumour
PSA
prostate specific antigen (NOT cancer specific)
elevated in benign prostate enlargement, UTI, prostatitis
70% with inc PSA will not have prostate cancer
6% with prostate cancer will not have inc PSA
management prostatic carcinoma
microscopic tumour - watchful waiting
if confined to gland - radical prostatectomy or radiotherapy = 80-90% 5y survival
need to remove adrogenic drive to the tumour - orchidectomy & synthetic luteinizing hormone
