Brainscape's Knowledge GenomeTM

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


See full index

IMED3002 > Tumours of the Bladder and Kidneys > Flashcards

Tumours of the Bladder and Kidneys Flashcards

1
Q

What are the types of renal tumours?

A

Benign

Malignant

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

What is the malignant type we need to know all about?

A

Clear cell renal carcinoma (75% of tumours that arise)

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

Who gets Renal Cell Carcinoma most commonly?

A

50% more in men

Usually between 50 and 70 years of age

Risk factors:
Smoking
Hypertension
Obesity
Occupational exposure to toxins
Genetic factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where do renal cell carcinomas come from?

A

The renal cortex

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

What does a tumour composed of clear cells look like under the microscope?

A

It is clear because cytoplasm is filled with carbohydrates and lipids and so the tumour looks yellow microscopically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Von Hippel-Lindau disease?

A

Disease in which people are unable to suppress tumours effectively due to a mutation in the VHL gene:

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

What happens to people with Von Hippel-Lindau disease?

A

People develop visceral cysts and tumours

Angiomas
Haemangioblastomas
Phaeochromocytomas
Renal cell carcinoma
Pancreatic cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What molecular mechanism causes sporadic clear cell RCC?

A

Loss of short arm of chromosome 3 either by deletion or unbalanced translocation and loss of one VHL gene.

Then other VHL gene undergoes mutation or hypermethylation

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

Which chromosome is the VHL gene on?

A

Chromosome 3

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

What happens when VHL is inactive?

A

IGF-1 is increased causing dysregulated cell growth.

IGF-1 upregulates hypoxia inducible factors which upregulate vascular endothelial growth factor (VEGF) and receptor causing new blood vessels to form

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

How do people present when they have RCC?

A

It was a silent cancer until very late in the disease.

Modern imaging means they often get picked up incidentally when other scans are being conducted

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

What are the classical symptoms of RCC?

A

Haemoturia

Abdominal mass

Flank pain

Weight loss, fever, scrotal varices (Veins in the scrotum start to engorge)

Abdominal masses can be palpated in skinny patients and feels firm non-tender and moves with respiration

Costovertebratl angle pain

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

When does haematuria occur?

A

When the carcinoma invades the collecting system which means its pretty bad at that stage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a potential complication with haematuria?

A

Clots can form that get stuck in the ureter which results in colicky pain

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

Why do scrotal varices occur?

A

IVC can be blocked by the carcinoma at the gonadal vein causing blood to pool at the scrotum.

This condition is very rare

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

What is renal cell carcinoma associated with? What other carcinoma is associated with this?

A

Paraneoplastic syndromes

Small cell carcinoma of the lung can cause this to occur too

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

What are some paraneoplastic syndrome effects?

A

Hypercalcaemia (from overproduction of parathyroid hormone or metastasis to the bone)

Erythrocytosis (overproduction of erythropoietin)

Hypertension (overproduction of renin)

Cushing syndrome (overproduction of ACTH)

Other cytokines cause fever and weight loss

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

What is a common association between Renal Cell Carcinoma and veins?

A

As the carcinoma grows it gains access to the veins in the renal sinus which then goes to the IVC which makes it spread to lung, bone, and brain :(

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What work is done when Renal Cell Carcinoma is suspected?

A

Abdominal CT

Chest CT

Biopsy

Bone scan if patient has bone pain

20
Q

How is renal cell carcinoma staged?

A

On the basis of presence of absence of regional lymph node metastasis

M0 or M1 on the basis of presence or absence of distant metastasis

T1 or T2 is how big its getting and whether or not its accessed the veins of the renal sinus or IVC

T4 is when it invades into gerotas fascia

21
Q

How is renal cell carcinoma treated typically?

A

Surgery as RCC is resistant to traditional chemotherapy and radiotherapy.

22
Q

What are the types of therapies taking place at the moment?

A

Immunomodulatory therapies eg PD1 inhibitors and IL-2

Targeted therapies (block VEGF pathway)

23
Q

Summary of RCC:

A

75% of cancers of the kidneys are clear cell renal cell carcinomas

Risk factors are smoking, obesity, and hypertension

Associated with inherited syndromes (VHL)

A silent cancer which may be present late or picked up incidentally

Classic triad: Haematuria, flank pain and palpable mass

Staged using the TNM system

24
Q

What are the most common bladder tumours?

A

Urothelial carcinoma (90%)

Small percentage of them are squamous cell carcinomas

25
Q

What is the previous name of urothelial carcinomas?

A

Transtional Cell Carcinoma

26
Q

Where does the Urothelial / transitional cell carcinoma occur?

A

Anywhere in the urinary tract most common in the bladder

Clinically divided into superficial, muscle-invasive, and metastatic urothelial carcinomas

27
Q

Who gets urothelial carcinomas?

A

Men more than women (3x)

Older people

Smokers

28
Q

What are the risk factors of bladder carcinoma?

A

Smoking

Occupational carcinogen exposure (painters, rubber industry workers, textile industry workers, metal workers)

(Potentially hairdressers.)

29
Q

What part of the bladder does the urothelial bladder cell carcinoma occur?

A

The urothelium

30
Q

What is the urothelium?

A

A multicellular tissue that is 3 - 7 cells thick and contains umbrella cell layer on surface to keep urine out of epithelium

31
Q

What are the 2 pathways of urothelial cell carcinoma?

A

Flat pathway when malignant cells form a patch on the bladder surface.

Papillary pathway take supporting stroma and grow upward and outward and form cauliflower like bodies

32
Q

What are the 2 types of bladder cancers>

A

P53 dependent (flat type and invade into bladder surface

P53 independent are low grade and less aggressive. They eventually lose P53 function and start metastasizing aggressively

33
Q

What are the features of urothelial cell carcinoma?

A

They are multifocal and grow on several different cells at once and recurrent where they keep occuring repeatedly.

34
Q

What are the 2 theories about the nature of urothelial cell carcinoma?

A

Field effect (Carcinogens acts on several cells of the bladder simultaneously)

Implantation theory (malignant cells float in urine and move from one place to another continuously

35
Q

What are the symptoms of urothelial cell carcinomas?

A

Haematuria (must always be investigated)

Frequency

Anaemia

Pain

No physical signs

36
Q

What can be done to investigate urothelial cell carcinoma?

A

Urine cytology (urine analysis malignant cells looked for in urine)

Cytoscopy (taking image of the inside of the bladder

Biopsy

Resection

Imaging of the upper urinary tract (multifocal carcinoma)

If metastasis is suspected chest CT and bone scans

37
Q

How is bladder cancer staged?

A

T1 into lamina propria
T2 into muscularis propria (deadly)
T3 paravesical fat
T4 adjacent organs

38
Q

When is bladder cancer said to be deadly?

A

When it invades the detrusor muscle

39
Q

What information does N staging use?

A

Absence or presence of nodal metastasis plus number of involved nodes (N0 to N3)

40
Q

What does M indicate in staging?

A

Absence or presence of distant metastasis (M0 or M1)

41
Q

How is urothelial carcinoma treated in non-muscle invasive urothelial carcinoma?

A

Resection

+/- local chemotherapy (attenuated version of tubercolosis used to fire up immune system)

42
Q

How is urothelial carcinoma treated in muscle invasive carcinoma?

A

Cystoprostatectomy

Radiation therapy

Chemotherapy

43
Q

What is the incidence of squamous cell carcinoma?

A

less than 5% of bladder cancer in NA/Europe/Aus

In countries with schistosomiasis it is greater than 75% of bladder cancers (Egypt, South Africa, parts of Asia)

44
Q

How do people get schistosomiasis?

A

They are located in water body which burrow through skin and they enter bladder which they irritate causing bladder cancer

45
Q

What does squamous cell carcinoma look like?

A

Keratin layer around it is white and hard

46
Q

Summary of bladder tumours

A

Usually urothelial carcinoma

More common in males

Cigarette smoking is a huge risk factor

Painless haematuria is a symptom

2 precursor lesions: Flat carcinoma and papillary urothelial carcinoma

TP53 and RB are central to development of muscle invasive urothelial carcinoma

Schistosomiasis infection is a risk factore for Squamous Cell Carcinoma

IMED3002 (46 decks)

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