Tumours

Question 1

what type of cancer is renal cell carcinoma? where does it arise from?

Answer 1

adenocarcinoma of renal cortex which arises from the proximal convoluted tubule

Question 2

risk factors renal cell carcinoma

Answer 2

smoking
obesity
HTN
renal failure
dialysis
polycystic & horseshoe kidneys
VHL (autosomal dom cond)

Question 3

clinical features renal cell carcinoma

Answer 3

classic triad: (HiLF)
haematuria
loin pain
a mass in the flank
other features: malaise, weight loss, fever

Question 4

renal cell carcinoma metastases?

Answer 4

25% have metastases at presentation to bone, liver and lung

Question 5

investigations renal cell carcinoma

Answer 5

USS to distinguish benign cyst from tumour
CT / MRI more sensitive
Percutaneous biopsy. Bone scan if Ca raised

Question 6

Management localised renal cell carcinoma

Answer 6

radical nephrectomy = preferred rx

partial nephrectomy if bilateral involvement or contralat kidney functions partly

Question 7

what can be used for pts who wouldnt tolerate surgery

Answer 7

ablative techniques eg cryoablation or radiofrequency

Question 8

Management metastatic/locally advanced renal cell carcinoma

Answer 8

interleukin-2 and interferon produce remission in 20% of cases

Question 9

prognosis renal cell carcinoma

Answer 9

5 yr survival 60-70% with tumours confined to renal parenchyma but less than 5% in those with distant metastases

Question 10

urothelial tumours affect what?

Answer 10

the calyces, renal pelvis, ureter, bladder and urethra are lines by transitional cell epithelium.
Bladder tumours are most common

Question 11

epidemiology bladder transitional cell (urothelial) tumours

Answer 11

after 40y

4x more common in males

Question 12

risk factors bladder cancer

Answer 12

cigarette smoking
exposure to industrial chemicals eg ß-naphthylamine, benzidine 
exposure to drugs eg cyclophosphamide
chronic inflammation eg schistomiasis
FHx

Question 13

what is schistomiasis

Answer 13

a parasite that causes chronic inflammation of the urinary tract = squamous cell carcinoma of the bladder
causes 50% of bladder cancers WW

Question 14

clinical features bladder urothelial transitional cell carcinoma

Answer 14

painless haematuria
symptoms suggestive of a UTI (frequency, urgency, dysuria) in the absence of bacteriuria
pain is usually due to metastatic disease

Question 15

transitional cell cancers of the kidney and ureters present with…

Answer 15

haematuria and flank pain

Question 16

investigations urothelial tumours

Answer 16

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

Question 17

management urothelial tumours

Answer 17

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

Question 18

What is TURBT?

Answer 18

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

Question 19

prostatic carcinoma - type of cancer?

Answer 19

adenocarcinoma

Question 20

epidemiology prostatic carcinoma

Answer 20

common
malignant change within prostate is inc common with inc age - present in 80% of men age 80 and over - most cases remain dormant

Question 21

clinical features prostatic carcinoma

Answer 21

screening for prostate cancer - serum PSA
bladder outflow obstruction
occasionally = symps of metastases to bone and nodes

Question 22

diagnosis prostatic carcinoma

Answer 22

transrectal US of the prostate
elevated serum PSA
transrectal prostate biopsy
endorectal coil MRI to stage tumour

Question 23

PSA

Answer 23

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

Question 24

management prostatic carcinoma

Answer 24

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

Question 25

what is an orchidectomy

Answer 25

removal of the testosterone producing part of the testes

Question 26

what do hormone therapies do in prostatic carcinoma

Answer 26

prevent release of testosterone = prevent tumour stimulation 80% are androgen sensitive

Question 27

screening prostate cancer

Answer 27

controversial
annual measurement of serum PSA and digital rectal exam reduces mortality but benefit is small and potential for overdiagnosis and over treatment related to complications

Question 28

testicular tumour epidemiology

Answer 28

most common cancer in young men

Question 29

testicular tumour arise from

Answer 29

germ cells

2 main types: seminomas & teratomas

Question 30

clinical features testicular tumour

Answer 30

typically man will find lump in testicle

presentation may be with metastases in the lungs = cough & dyspnoea or para-aortic lymph nodes, causing back pain

Question 31

Investigations testicular tumour

Answer 31

USS to identify mass
serum conc of tumour markers a-fetoprotein (AFP) are elevated in teratomas
The ß subunit of human chorionic gonadotrophin (ß-hCG) are elevated in teratomas and seminomas
used for diagnosis and response to rx

Question 32

rx testicular tumour

Answer 32

orchidectomy
seminomas w metastases below diaphragm =radiotherapy
more widespread = chemo
sperm banking should be offered prior rx

Question 33

3 ways of metastatic spread

Answer 33

lymphatic
haematogenous
transcleromic

Question 34

paraneoplastic syndromes
endocrine: 
neurological: 
dermatological:
haematological:

Answer 34

endocrine: cushings disease
neurological: dementia, cerebellar degeneration, peripheral neuropathy
dermatological: acanthosis nigricans
haematological: erythrocytosis