Tumours

Question 1

List the main benign renal tumours

Answer 1

Fibroma
Adenoma
Angiomyolipoma
Juxtaglomerular cell tumour (JGCT)

Question 2

Which area of the kidney do fibromas originate from?

Answer 2

Medulla

Question 3

Which area of the kidney do adenomas originate from?

Answer 3

Cortex

Question 4

Which condition is associated with angiomyolipoma?

Answer 4

Tuberous sclerosis

Question 5

JGCT can cause primary hypertension. True/False?

Answer 5

False

Secondary hypertension; secrete renin

Question 6

List the main malignant renal tumours

Answer 6

Nephroblastoma
Urothelial carcinoma
Renal cell carcinoma

Question 7

Which malignant renal tumour is commonest in children and adults?

Answer 7

Nephroblastoma in children

Renal cell carcinoma in adults

Question 8

Where do nephroblastoma arise from?

Answer 8

Residual primitive renal tissue

Question 9

Where do renal cell carcinoma arise from?

Answer 9

Renal tubular epithelium

Question 10

List clinical features of renal cell carcinoma

Answer 10

Abdominal mass
Haematuria
Flank pain
Hypercalcaemia
Polycythemia (raised RBC)

Question 11

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

Answer 11

True

Can extend into vena cava and right atrium

Question 12

Which type of renal cell carcinoma is the most common?

Answer 12

Clear cell type - rich in glycogen and lipid

Question 13

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

Answer 13

Transitional cell carcinoma (of transitional epithelium)

Question 14

List risk factors for transitional cell carcinoma

Answer 14

Dyes
Rubber industry
Cyclophosphamide
Smoking

Question 15

Where do 75% of transitional cell carcinomas occur?

Answer 15

Region of trigone, leading to ureteric obstruction

Question 16

What is the main tumour that affects the penis?

Answer 16

Squamous cell carcinoma in situ

Question 17

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

Answer 17

Uncircumcised men

Also note poor hygiene + HPV infection

Question 18

What occupation was linked with SCC of the scrotum?

Answer 18

Chimney sweeps

Question 19

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

Answer 19

True

Question 20

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

Answer 20

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

Question 21

List clinical features of BNH of prostate and general prostatism

Answer 21

Difficulty in starting micturition
Poor stream
Overflow incontinence

Question 22

How is BNH of prostate managed?

Answer 22

Surgery - transurethral resection

Drugs - alpha blocker, 5-alpha-reductase inhibitor

Question 23

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

Answer 23

False

Question 24

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

Answer 24

False

Not associated but both can occur at once

Question 25

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

Answer 25

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

Question 26

What effect can prostate carcinoma have on bone?

Answer 26

Osteosclerotic metastases

Question 27

List investigations for prostate carcinoma

Answer 27

PR exam Ultrasound/XR Prostate Specific Antigen (PSA) Biopsy

Question 28

List management for prostate carcinoma

Answer 28

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

Question 29

State a major risk factor for developing testicular tumour

Answer 29

Testicular maldescent

Question 30

How do testicular tumours usually present?

Answer 30

Painless testicular enlargement

Question 31

Name the most common class of testicular tumour

Answer 31

Germ cell tumour (seminoma, teratoma)

Question 32

What is the commonest germ cell tumour?

Answer 32

Seminoma

Question 33

Seminomas are very rare before puberty. True/False?

Answer 33

True

Question 34

Which tumour marker is useful for identifying seminoma?

Answer 34

Placental alkaline phosphatase (PLAP)

Question 35

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

Answer 35

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

Question 36

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

Answer 36

Transitional zone

Question 37

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

Answer 37

Asymmetry Nodule Hard, craggy mass

Question 38

Which marker is usually used to detect prostatic disease?

Answer 38

PSA (prostate specific antigen)

Question 39

Where is PSA produced?

Answer 39

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

Question 40

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

Answer 40

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

Question 41

Is specificity of PSA for cancer high or low?

Answer 41

Low (40%) | Can be raised in prostatitis, UTI, catheterisation

Question 42

How is a biopsy of prostate cancer taken?

Answer 42

``` Trans-rectal ultrasound-guided approach 10 biopsies (5 from each lobe) taken ```

Question 43

What is the majority of prostate cancer?

Answer 43

Multifocal adenocarcinoma

Question 44

What are the most common sites for prostate adenocarcinoma metastasis?

Answer 44

Pelvic lymph nodes | Skeleton (osteosclerosis)

Question 45

Which score is used to grade prostate malignancy?

Answer 45

Gleason score | Also use bone scan/MRI/CT

Question 46

Outline management of organ-confined prostate cancer

Answer 46

Watchful waiting/symptom-guided | Active monitoring

Question 47

Outline management of locally-advanced prostate cancer

Answer 47

Radiotherapy + hormonal therapy

Question 48

Outline management of metastatic prostate cancer

Answer 48

Androgen-deprivation therapy Steroids Cytotoxic chemotherapy

Question 49

How do LHRH agonists provide hormonal therapy in prostate cancer?

Answer 49

Stimulate pituitary to increase LH/FSH which increases testosterone

Question 50

What is the majority of urothelial tumours?

Answer 50

Transitional cell carcinoma

Question 51

Most transitional cell carcinoma is papillary. True/False?

Answer 51

True | 20% non-papillary