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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
What effect can prostate carcinoma have on bone?
OsteoSCLEROTIC metastases
26
List investigations for prostate carcinoma
PR exam US/ XR Prostate Specific Antigen (PSA) TRUS biopsy
27
List management for prostate carcinoma
Anti-androgen drug Radiotherapy if bone metastases Surgery (prostatectomy)
28
State a major risk factor for developing testicular tumour
Undescended testes
29
How do testicular tumours usually present?
Painless insensitive testicular enlargement in males 20-35yo
30
Name the most common class of testicular tumour
Germ cell tumour: seminoma non-seminomatous (teratoma, embryonal, yolk sac, choriocarcinoma)
31
What is the commonest germ cell tumour?
Seminoma
32
Seminomas are very rare before puberty. True/False?
True
33
Which tumour marker is useful for identifying seminoma and teratoma, respectively?
Placental alkaline phosphatase (PLAP) | AFP, bHCG
34
List the zonal anatomy of the prostate in order of most-least % origin of prostate cancer
Peripheral (70%) Transitional (20%) Central (5%)
35
Which zone of the prostate gives rise to benign prostate hyperplasia?
Transitional zone
36
List abnormal findings of a digital rectal exam that could indicate prostate cancer
Asymmetry Nodule Hard, craggy mass
37
Which marker is usually used to detect prostatic disease?
PSA (prostate specific antigen)
38
Where is PSA produced?
Enzyme produced by secretory epithelial cells of prostate gland, involved in liquefying semen
39
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
40
Is specificity of PSA for cancer high or low?
Low (40%) | Can be raised in prostatitis, BPH, UTI, retention, catheterisation, after PR exam
41
How is a biopsy of prostate cancer taken?
``` Trans-rectal ultrasound-guided approach 10 biopsies (5 from each lobe) taken ```
42
What is the majority of prostate cancer?
Multifocal adenocarcinoma
43
What are the most common sites for prostate adenocarcinoma metastasis?
Pelvic lymph nodes | Skeleton (osteosclerosis)
44
Which score is used to grade prostate malignancy?
Gleason score | Also use bone scan/MRI/CT
45
Outline management of organ-confined prostate cancer
Watchful waiting/symptom-guided | Active monitoring
46
Outline management of locally-advanced prostate cancer
Radiotherapy + hormonal therapy
47
Outline management of metastatic prostate cancer
Androgen-deprivation therapy Steroids Cytotoxic chemotherapy
48
How do LHRH agonists vs. anti-androgens provide hormonal therapy in prostate cancer?
Stimulate pituitary to increase LH/FSH which reduces testosterone, causing prostate cell apoptosis Compete with testosterone for prostate binding sites in nucleus
49
What is the majority of urothelial tumours?
Transitional cell carcinoma (90%) | Squamous (9%)
50
Most transitional cell carcinoma is papillary. True/False?
True | 20% non-papillary
51
How is renal cell carcinoma diagnosed and staged?
US CT triple phase contrast Biopsy Robson staging
52
List the common sites of metastases for renal cell carcinoma?
Lungs Liver Bone Brain
53
Outline management for renal cell carcinoma
Radical nephrectomy Partial nephrectomy Radiofrequency ablation Cryoblation
54
Renal cell carcinoma is associated with which genetic condition?
VHL
55
List clinical signs of BXO
White patches Fissures Bleeding Scars
56
List management options for BXO
Prepuce, glans, urethral extension Circumcision Meatal stenosis dilatation Glans resurfacing
57
List types of penile tumours
Squamous cell carcinoma in situ Invasive SCC Pre-malignant lesions (BXO, leukoplakia)
58
List management options for SCC-in-situ of penis
Circumcision if only prepuce Topical 5FT Imiquomoid Laser
59
List clinical signs of invasive penile SCC
``` Elderly male with: Red raised area Fungating mass Phimosis Foul smell ```
60
Outline the diagnosis and staging of invasive penile SCC
1st line: US 2nd line: MRI Sentinal node biopsy TNM
61
List management options for invasive penile SCC
Penis preserving local excision/ resurfacing Total/ partial penectomy and reconstruction Inguinal lymphadectomy Radiotherapy Palliative chemo
62
Outline the diagnosis and staging of testicular tumour
1st line: US Tumour markers Orchidectomy (take out tumour for staging) TNM
63
List management options for testicular tumours
Surveillance Sperm storage Radiotherapy Residual post-treatment masses
64
List the four main causes of haematuria with examples of each
BENIGN: inflammation, BPH, stones, infection MALIGNANT: renal, penile, bladder cancer TRAUMA: sports OTHER
65
What is the most common malignancy in UK men?
Prostate cancer (70-74yo)
66
List symptoms of prostate cancer
``` Typically asymptomatic LUT signs Haematuria/ haematospermia Bone pain Weight loss ```
67
List imaging used in the diagnosis and staging of bladder cancer
CT urogram | Flexible cystoscopy for biopsy
68
What is the characteristic sign of bladder cancer on imaging?
Urinary bladder halo sign
69
List management options for bladder cancer
TURBT (removal of tumour) or local diathergy Urinary divulsion (removal of bladder and stenting) Radical radiotherapy Cisplatin based chemotherapy
70
Outline key points for a history of haematuria
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
What is the classical symptom characteristic of bladder cancer?
Painless haematuria
72
What is 'haematuria'?
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
State the characteristic sign of oncoytoma on imaging?
Central scar on CT

Y2 RENAL (17 decks)

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