Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Renal / Urology > Tumours of Prostate and Testicles > Flashcards

Tumours of Prostate and Testicles Flashcards

1
Q

Where does prostate cancer affect

A

Peripheral zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of cancer if prostate

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the symptoms of prostate cancer

A 
Asymptomatic - Dx on PSA
Prostate obstruction Sx / similar to BPH
- Frequency
- Poor flow
- Terminal dribbling 
- Incomplete emptying 
- Overflow incontinence
Haematuria
Suprapubic pain
Erectile dysfunction 
Impotence
Incontinence 
Anuria 
Haemospermia 
Rectal symptoms
Lethargy
UTI 
Weight loss / fatigue / bone pain suggests mets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why don’t you tend to get BPE symptoms

A

In peripheral zone not transitional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does mets present / complications of prostate cancer

A 
Renal failure
Sciatica if in sacrum 
Spinal cord compression 
Paraplegia due to cord compression
Lymphoedema
Bone pain
Pathological fractures - CXR if present 
Features of bone marrow failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does prostate cancer spread

A

Local - seminal vesicle / bladder (gives pelvic pain and urinay Sx)
Lymph
Haematagenous - pelvis / bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the RF for prostate cancer

A 
Age 
Ethnicity - black 
FH
Increased testosterone / use of steroid
BRCA 2 / HBC1
Diet 
Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you investigate suspected prostate cancer

A

PSA - not good for screening for good for progression
Do this prior to DRE
DRE
FBC, U+E, bone profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does DRE show

A

Hard irregular prostate

Loss median sulcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is diagnostic for prostate cancer

A

MRI scan = 1st line now due to complications of biopsy
MRI guided biopsy depending on result of MRI
TRUS (trans rectal USS) guided biopsy
Allows Dx and Gliasen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is 1st line to stage

A

MRI = 1st line was TRUS
CT for nodes if higher risk
Bone scan for mets if higher risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When should you refer for further investigation

A

PSA >3

Abnormal DRE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can elevate PSA

A 
Age
Cancer
BPH 
Prostatiits / UTI
Catheter
Ejaculation
DRE
Urine retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What else can be done

A

Rectal swab for sensitivity if need Ax post biopsy

Micturating cystogram for bladder Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are complications of biopsy

A

Infection

Bleeding - PR or haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do you give before biopsy

A

Prophylactic Ax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do you grade

A

Glieesen grade

Each side 3,4,5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do you do for localised disease

A 
Watch and wait
Active surveillance
Radical RT
- External beam therapy
- Brachytherapy 
Radical prostatectomy = standard + seminal vesicle + pelvic LN 
TURP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When would you watch an wait

A

Unfit

Low Gliasen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When do you do active surveillance

A

If fit but no symptoms as complications of Rx will worsen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does TURP do

A

Relieve obstructive Sx but NOT curative

Use if not fit for radical prostatectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do you do for locally advanced

A

Same

Hormone therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does hormone therapy do

A

Delays progression
Doesn’t cure
Testosterone drives cancer so suppress

24
Q

What are options of hormone therapy

A

GnRH agonist (goreslin)
- First stimulates receptors and causes an increase in Sx
- Bone pain / cord compression / AKI / acute retention / coagulation abnormalities causing fatal CVS
- Give with anti-androgen - (Flutamide / Cryprecipitte) 3 days prior to starting
GnRH antagonist
Anti-androgen
Oestrogen
BIlateral orchidectomy

25
Q

What is symptomatic Rx

A

Analgesia
Biphosphonates for hypercalcaemia
RT for bone mets or spinal compression

26
Q

What is active surveillance

A

PSA level + DRE every few months

Biopsy /MRI annual or if any concern

27
Q

What is watchful waiting

A

Waiting for symptoms to show

28
Q

What are prognostic factors

A

Pre-treatment PSA
Gleason
Tumour stage - T from DRE
Tumour grade

29
Q

What are complications of RT and prostactetmoy

A 
Rectal, bladder and colon cancer
Proctitis
Urethral stricture
Erectile dysnfction
Urinary incontinence
30
Q

What is the commonest malignancy in the young

A

Testicular cancer

Must rule out if any swelling in young

31
Q

What is the most common testicular cancer

A

Germ cell = 90%

Non seminomatous = most common germ

  • Teratoma
  • Yolk
  • Choriocarcinma
  • Raised AFP + bHCG

Seminomatous
- No raised AFP but can have raised bHCG

32
Q

What are non germ cell

A

Leydic
Sertoli
Lymphoma
Sarcoma

33
Q

How does testicular cancer present

Where does it metastasis too

A 
Painless lump
Irregular 
Hard without fluctuantance or transillumination 
Haemospermia
Tender inflamed lump
Pre-aortic LN = abdo mass
Secondary hydrocele
Gynaecomastia
Hormone secretion
AFP and LDH increases

Lungs = SOB so always get a CXR if suspect
Liver
Brain

34
Q

What are the RF for testicular cancer

A 
Young
Caucasian
Testicular maldescent
Infertility
Atrophic testic
Previous cancer
Klienfelter
Mumps
Orchitis
35
Q

How do you Dx

A 
FBC 
MSSU
USS scotrum = 1st line
Biopsy = NOT as will seed tumour 
Can only Dx by excision and histology 
Do bHCG / ALP / AFP if USS suggest cancer
36
Q

How do you stage

A

CT CAP

CXR for lung mets (typically cannon-ball)

37
Q

What tumour markers in resticular cancer and how do you monitor after Rx

A

AFP
BHG - non-seminoamtous
LDH
Often normal in seminomas

Monitoring = tumour marker and imaging

38
Q

How do you treat testicular cancer and mets

A 
Radical orchiectomy
Biopsy contralateral
RT in SGCT
Chemotherapy if nodal or mets
Seminoma have slightly better prognosis
Surveillance every 18-24 months with CT + tumour marker
39
Q

What are your differentials

A 
Hydrocele
Varicocele
Epndidymal cyst
Inguinal hernia
True testicular lump 
Torsion 
Infection
40
Q

What is a sign of renal cancer

A

L varicocele - always do renal USS

41
Q

Complications of prostatectomy (diff to TURP)

A

Erectile dysfunction
Incontinence
Urethral stenosis

42
Q

What does penile cancer tend to be

A

SCC

43
Q

What are RF

A 
HPV
Multiple partner
Smoking
Pre-malignant
Bowens
44
Q

Presentation

A 
Painless sore or ulcer
Bleeding
Discharge
Inguinal lympahdenopathy 
Many present late
45
Q

Where does it spread too

A 
Inguinal and iliac nodes
Distant to para-aortic and mediastinal nodes
Liver
Lung
Bone
Brain
46
Q

How do you Dx

A

Biopsy / cytology of lesion or nodes
SNB
USS / MRI for depth of invasion
CT CAP / bone scan for stage

47
Q

When do you reassess nodes

A

4-6 weeks after treatment of primary

48
Q

How do you follow up

A

Assessment of primary / nodes

CT if N2

49
Q

How do you treat early disease

A

Laser therapy
Excision biopsy
RT

50
Q

How do you treat T2-T4

A

Surgery = mainstay
Palliative chemo or RT
Bilateral lymphadenoectomy

51
Q

How do you treat inguinal LN

A

Surveillance if T1NO
Bilateral lymhpadenctomy if T2-T4
+- chemo / RT if N1
Palliative chemo or RT if N3

52
Q

What is protective against penile cancer

A

Circumcision

53
Q

What does prognosis depend on

A

Seminoma better prognosis than teratoma
High T stage
Age
LN +ve

54
Q

What are SE of hormonal therapy

A 
Impotence
Flushing
Sweats
Muscle weakness
Osteoporosis
Gynaecomastia
Weight gain 
Depression
55
Q

How do you follow up teratoma / non-seminatous

A

CT and AFP and bHCG

Renal / Urology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions