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Y2 RENAL > Tumours > Flashcards

Tumours Flashcards

1
Q

List the main benign renal tumours

A 
Renal cysts
Fibroma
Adenoma
Oncotyma
Angiomyolipoma
Juxtaglomerular cell tumour (JGCT)
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2
Q

Which area of the kidney do fibromas originate from?

A

Medulla

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3
Q

Which area of the kidney do adenomas originate from?

A

Cortex

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4
Q

Which condition is associated with angiomyolipoma?

A

Tuberous sclerosis

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5
Q

JGCT can cause primary hypertension. True/False?

A

False

Secondary hypertension; secrete renin

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6
Q

List the main malignant renal tumours

A

Nephroblastoma
Urothelial carcinoma
Renal cell carcinoma

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7
Q

Which malignant renal tumour is commonest in children and adults?

A

Nephroblastoma in children

Renal cell carcinoma in adults

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8
Q

Where do nephroblastoma arise from?

A

Embryonic tissue

Residual primitive renal tissue

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9
Q

Where do renal cell carcinoma arise from?

A

Renal parenchyma

Renal tubular epithelium

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10
Q

List clinical features of renal cell carcinoma

A 
TRIAD: Abdominal mass
            Haematuria
            Flank pain
Hypercalcaemia
Polycythemia (raised RBC)
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11
Q

Renal vein extension is common in renal cell carcinoma. True/False?

A

True

Can extend into vena cava and right atrium

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12
Q

Which type of renal cell carcinoma is the most common?

A

Clear cell type - rich in glycogen and lipid

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13
Q

Which malignant tumour affects the area between the pelvicalyceal system to the urethra?

A

Transitional cell carcinoma (of transitional epithelium)

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14
Q

List risk factors for transitional cell carcinoma

A

Male >50yo
Dyes
Rubber industry (amine exposure)
Smoking

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15
Q

Where do 75% of transitional cell carcinomas occur?

A

Region of trigone, leading to ureteric obstruction

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16
Q

What is the main tumour that affects the penis? List types of this tumour. What is the main sign?

A

Squamous cell carcinoma in situ
Erthroplasia of Queryat (glans, prepuce, shaft)
Bowen’s disease (rest of genitalia)
Red velvety patches

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17
Q

Which group of individuals are particularly susceptible to squamous cell carcinoma of the penis?

A

Uncircumcised men

Also note poor hygiene + HPV infection

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18
Q

At least 75% of men over 70 are affected by benign nodular hyperplasia of prostate. True/False?
What is BNH?

A

True

Irregular proliferation of glandular and stromal prostatic tissue

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19
Q

What is the proposed aetiology behind benign nodular hyperplasia of prostate (BNH)?

A

Hormone imbalance - androgen decreases as get older but oestrogen level remains same; gland is oestrogen responsive

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20
Q

List clinical features of BNH of prostate and general prostatism

A

Difficulty in starting micturition
Poor stream
Overflow incontinence

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21
Q

How is BNH of prostate managed?

A

Surgery - transurethral resection

Drugs - alpha blocker, 5-alpha-reductase inhibitor

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22
Q

BNH of prostate is pre-malignant. True/False?

A

False

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23
Q

Carcinoma of prostate is associated with BNH of prostate. True/False?

A

False

Not associated but both can occur at once

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24
Q

Why do symptoms of carcinoma of prostate only arise when the disease is more advanced?

A

Carcinoma arises in peripheral ducts and glands, so peri-urethral (bladder obstructive) area is involved at later stage

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25
Q

What effect can prostate carcinoma have on bone?

A

OsteoSCLEROTIC metastases

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26
Q

List investigations for prostate carcinoma

A

PR exam
US/ XR
Prostate Specific Antigen (PSA)
TRUS biopsy

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27
Q

List management for prostate carcinoma

A

Anti-androgen drug
Radiotherapy if bone metastases
Surgery (prostatectomy)

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28
Q

State a major risk factor for developing testicular tumour

A

Undescended testes

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29
Q

How do testicular tumours usually present?

A

Painless insensitive testicular enlargement in males 20-35yo

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30
Q

Name the most common class of testicular tumour

A

Germ cell tumour:
seminoma
non-seminomatous (teratoma, embryonal, yolk sac, choriocarcinoma)

31
Q

What is the commonest germ cell tumour?

A

Seminoma

32
Q

Seminomas are very rare before puberty. True/False?

A

True

33
Q

Which tumour marker is useful for identifying seminoma and teratoma, respectively?

A

Placental alkaline phosphatase (PLAP)

AFP, bHCG

34
Q

List the zonal anatomy of the prostate in order of most-least % origin of prostate cancer

A

Peripheral (70%)
Transitional (20%)
Central (5%)

35
Q

Which zone of the prostate gives rise to benign prostate hyperplasia?

A

Transitional zone

36
Q

List abnormal findings of a digital rectal exam that could indicate prostate cancer

A

Asymmetry
Nodule
Hard, craggy mass

37
Q

Which marker is usually used to detect prostatic disease?

A

PSA (prostate specific antigen)

38
Q

Where is PSA produced?

A

Enzyme produced by secretory epithelial cells of prostate gland, involved in liquefying semen

39
Q

In healthy people serum PSA is high. True/False?

A

False
Semen levels of PSA are high but serum is normal in normal people
High PSA in serum suggests cancer

40
Q

Is specificity of PSA for cancer high or low?

A

Low (40%)

Can be raised in prostatitis, BPH, UTI, retention, catheterisation, after PR exam

41
Q

How is a biopsy of prostate cancer taken?

A 
Trans-rectal ultrasound-guided approach
10 biopsies (5 from each lobe) taken
42
Q

What is the majority of prostate cancer?

A

Multifocal adenocarcinoma

43
Q

What are the most common sites for prostate adenocarcinoma metastasis?

A

Pelvic lymph nodes

Skeleton (osteosclerosis)

44
Q

Which score is used to grade prostate malignancy?

A

Gleason score

Also use bone scan/MRI/CT

45
Q

Outline management of organ-confined prostate cancer

A

Watchful waiting/symptom-guided

Active monitoring

46
Q

Outline management of locally-advanced prostate cancer

A

Radiotherapy + hormonal therapy

47
Q

Outline management of metastatic prostate cancer

A

Androgen-deprivation therapy
Steroids
Cytotoxic chemotherapy

48
Q

How do LHRH agonists vs. anti-androgens provide hormonal therapy in prostate cancer?

A

Stimulate pituitary to increase LH/FSH which reduces testosterone, causing prostate cell apoptosis
Compete with testosterone for prostate binding sites in nucleus

49
Q

What is the majority of urothelial tumours?

A

Transitional cell carcinoma (90%)

Squamous (9%)

50
Q

Most transitional cell carcinoma is papillary. True/False?

A

True

20% non-papillary

51
Q

How is renal cell carcinoma diagnosed and staged?

A

US
CT triple phase contrast
Biopsy

Robson staging

52
Q

List the common sites of metastases for renal cell carcinoma?

A

Lungs
Liver
Bone
Brain

53
Q

Outline management for renal cell carcinoma

A

Radical nephrectomy
Partial nephrectomy
Radiofrequency ablation
Cryoblation

54
Q

Renal cell carcinoma is associated with which genetic condition?

A

VHL

55
Q

List clinical signs of BXO

A

White patches
Fissures
Bleeding
Scars

56
Q

List management options for BXO

A

Prepuce, glans, urethral extension
Circumcision
Meatal stenosis dilatation
Glans resurfacing

57
Q

List types of penile tumours

A

Squamous cell carcinoma in situ
Invasive SCC
Pre-malignant lesions (BXO, leukoplakia)

58
Q

List management options for SCC-in-situ of penis

A

Circumcision if only prepuce
Topical 5FT
Imiquomoid
Laser

59
Q

List clinical signs of invasive penile SCC

A 
Elderly male with:
Red raised area
Fungating mass
Phimosis
Foul smell
60
Q

Outline the diagnosis and staging of invasive penile SCC

A

1st line: US
2nd line: MRI
Sentinal node biopsy

TNM

61
Q

List management options for invasive penile SCC

A

Penis preserving local excision/ resurfacing
Total/ partial penectomy and reconstruction
Inguinal lymphadectomy
Radiotherapy
Palliative chemo

62
Q

Outline the diagnosis and staging of testicular tumour

A

1st line: US
Tumour markers

Orchidectomy (take out tumour for staging)
TNM

63
Q

List management options for testicular tumours

A

Surveillance
Sperm storage
Radiotherapy
Residual post-treatment masses

64
Q

List the four main causes of haematuria with examples of each

A

BENIGN: inflammation, BPH, stones, infection
MALIGNANT: renal, penile, bladder cancer
TRAUMA: sports
OTHER

65
Q

What is the most common malignancy in UK men?

A

Prostate cancer (70-74yo)

66
Q

List symptoms of prostate cancer

A 
Typically asymptomatic
LUT signs
Haematuria/ haematospermia
Bone pain
Weight loss
67
Q

List imaging used in the diagnosis and staging of bladder cancer

A

CT urogram

Flexible cystoscopy for biopsy

68
Q

What is the characteristic sign of bladder cancer on imaging?

A

Urinary bladder halo sign

69
Q

List management options for bladder cancer

A

TURBT (removal of tumour) or local diathergy
Urinary divulsion (removal of bladder and stenting)
Radical radiotherapy
Cisplatin based chemotherapy

70
Q

Outline key points for a history of haematuria

A

HoPC:
voiding, storage, sytemic symptoms
frequency, urgency, dysuria, fever, sweating, fluey, shivery, loin/ suprapubic pain,
nature of haematuria (vermiform wormy clots and flank pain = upper UT, dark blood with clots = old, fresh red blood = recent)
timing of pee (inital = urethra, terminal = prostate/ bladder, total - bladder/ upper UT)

PMHx of bleeding disorder/ UTI
DHx of warfarin
FHx of malignancy
SHx of smoking (uroepithelial cancer), occupational risk (chemicals, rubber), travel

71
Q

What is the classical symptom characteristic of bladder cancer?

A

Painless haematuria

72
Q

What is ‘haematuria’?

A

Haematuria refers to the presence of blood in the urine, as defined as more than 3-5 red blood cells per high-power field (RBC/hpf)

73
Q

State the characteristic sign of oncoytoma on imaging?

A

Central scar on CT

Y2 RENAL (17 decks)

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