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Year 2 Urinary (JK) > Tumours of the urinary system 1 - prostate and testicular > Flashcards

Tumours of the urinary system 1 - prostate and testicular Flashcards

1
Q

What age is prostate cancer most common?

A

over 65

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2
Q

Describe the epidemiology of prostate cancer

A

most common cancer diagnosis in men

2nd most common cause of death in men - cancer

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3
Q

Risk factors for prostate cancer

A 
age 
race/ethnicity - African living in western countries 
family history 
food - probable 
drugs - 5 alpha reductase inhibitors
geography
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4
Q

What do 5 alpha reductase inhibitors do to the prostate cancer risk?

A

relative reduced risk 25-30%

increase risk of high grade tumours

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5
Q

Where do each of these develop in the prostate zones?
1 - BPH
2 - prostate cancer

A

1 - transitional

2 - peripheral

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6
Q

What cell type is prostate cancer?

A

adenocarcinoma

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7
Q

How are most prostate cancers picked up?

A

opportunistic PSA testing

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8
Q

Diagnostic triad of prostate cancer

A

PSA
digital rectal examination
TRUS guided biopsy

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9
Q

Is PSA specific?

A

prostate specific but not cancer specific

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10
Q

Localised prostate cancer symptoms (? more to do with BPH)

A

weak stream, hesitancy, sensation of incomplete emptying, frequency, urgency, urge incontinence, urinary tract infection

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11
Q

Locally invasive disease symptoms

A 
haematuria 
perineal and suprapubic pain 
impotence 
incontinence 
loin pain or anuria due to ureter obstruction 
symptoms of renal failure
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12
Q

Distant mets symptoms

A

bone pain or sciatica
lymph node enlargement
paraplegia - spinal cord compression

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13
Q

Widespread mets symptoms

A

lethargy - anaemia, uraemia

weight loss and cachexia

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14
Q

Why is prostate cancer not screened for?

A

Wilson-junger criteria not met
does not improve survival
leads to over diagnosis & treatment

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15
Q

Basis of PSA

A

kallikrein serine protease helps liquify semen and produced by prostate - may leak into serum

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16
Q

Threshold for PSA is dependent on?

A

age

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17
Q

7 reasons for increased PSA levels

A 
BPH 
prostate cancer 
chronic prostatitis 
instrument eg catheter 
urological procedure 
physiological eg ejaculation 
UTI
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18
Q

Half life of PSA

A

2.2 days

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19
Q

If repeat PSA needed when would it be done?

A

3 weeks eg 8 half lives later

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20
Q

What is meant by grading of cancer?

A

how aggressive it is histologically

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21
Q

Levels of grading in prostate cancer

A

3 to 5

3 well differentiated and 5 poor

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22
Q

How is the grading of prostate cancer done?

A

gleason SUM score

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23
Q

Describe the gleason sum score

A

score of the 2 main histological grades with the 1st one being more common

24
Q

Why is the gleason sum score useful?

A

prognosis and treatment

25
Q

Describe the IPUS score in terms of gleason sum score

A 
1 - 3+3
2 - 3+4
3 - 4+3
4 - 8
5 - 9 &10
26
Q

How many stages of prostate cancer is there?

27
Q

What are the 4 stages of prostate cancer?

A

localised
locally advanced
mets stage
hormone refractory stage

28
Q

5 ways to stage localised prostate cancer

A 
CT
MRI
PSA
digital rectal examination 
TRUS guided biopsy
29
Q

3 treatments for localised prostate cancer and 2 other under investigation

A

watchful waiting
radiotherapy - external beam, brachytherapy
radical prostatectomy - open, laparascopic or endoscopic
1 - cryotherapy 2 - thermotherapy

30
Q

5 treatment regimes of locally advanced prostate cancer

A 
watchful waiting 
hormone therapy followed by surgery 
hormone therapy followed by radiation 
hormone therapy alone
intermittent hormone therapy
31
Q

4 types of hormone therapy

A

surgical castration eg bilateral orchidectomy
chemical castration
anti-androgens
oestrogens

32
Q

other organ complications of mets and hormone refractory prostate cancer

A

bones - pain, fractures, anaemia, spinal cord compression
rectal - constipation, bowel obstruction
ureteric - obstruction resulting in renal failure
Pelvic lymphatic obstruction - lymphoedema, DVT
LUT dysfunction - haematuria, acute retention

33
Q

Supportive treatment in prostate cancer

A

palliative radiotherapy, colostomy etc

34
Q

How do most testicular cancers present?

A

painless lump

35
Q

Less often ways testicular cancer presents

A

tender inflamed swelling
history of trauma - notice lump
nodal or distant mets symptoms

36
Q

who is testicular cancer common in?

A

young men (30’s), caucasian

37
Q

Risk factors for testicular cancer

A

testicular madescent
infertility
contralateral testicular cancer
FH

38
Q

Precursor lesion of testicular cancer

A

Testicular germ cell neoplasia in situ

39
Q

Blood for tumour markers are taken when?

A

immediately before and serially after surgery

40
Q

3 tumours markers for testicular cancer

A

AFP
BHCG
LDH

41
Q

What testicular cancers are AFP and BHCG used for?

A

AFP - Teratoma

BHCG - seminoma

42
Q

3 differential diagnoses for lump in testis apart from cancer

A

infection
epididymal cyst
missed testicular torsion

43
Q

3 investigations of painless lump in testis

A

MSSU
testicular ultrasound scan and CXR
tumour markers

44
Q

Treatment for testicular cancer

A

radical orchidectomy is essential

45
Q

When would a biopsy of contralateral testis be needed?

A

high risk for tumour

46
Q

What does further treatment after radical orchidectomy depend on?

A

tumour type, stage (TNM) and grade

47
Q

What lymph nodes does testicular cancer spread to?

A

para aortic lymph nodes

48
Q

Where is the incision made in a radical orchidectomy and why?

A

inguinal region

prevent obstructing lymphatics

49
Q

Histological cell type of testicular cancer

A

germ cell tumour

50
Q

2 types of germ cell tumour

A

seminomatous

non seminomatous

51
Q

Main non seminomatous testicular cancer

52
Q

How is local staging of testicular cancer done?

A

pathological assessment of orchidectomy

53
Q

Method of nodal and distant testicular cancer staging

54
Q

4 stages of testicular cancer

A

1: confined to testis
2: infradiaphragmatic nodes
3: supradiaphragmatic nodes
4: extra lymphatic disease

55
Q

Low stage, -ve markers further treatment of testicular cancer

A

surveillance
adjuvant radiotherapy
prophylactic chemo

56
Q

nodal disease/persistent tumour markers/relapse further treatment of testicular cancer

A

combination chemo

LN dissection

57
Q

Prognosis of testicular cancer

A

stage 1 : 99% 5YS
stage 2/3: 96% 5YS
stage 4: 73% 5YS

Year 2 Urinary (JK) (26 decks)

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