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2ND YEAR SYSTEMS: Urinary > Tumours of the urinary system 1 (Testicular and Prostate cancer) > Flashcards

Tumours of the urinary system 1 (Testicular and Prostate cancer) Flashcards

1
Q

What is the most common cancer diagnosed in men?

A

Prostate cancer

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2
Q

Aetiology and RFs for prostate cancer

A

Age

Race/Ethnicity

Geography

Family history - first degree relative 2x risk

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3
Q

Which genes are related to prostate cancer?

A

HPC1

BRAC1 and 2

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4
Q

What are McNeal’s’ prostatic zones?

A

Transition zone

Central zone

Anterior fibromuscular stroma

Peripheral zone

4 areas of the prostate

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5
Q

Which zone is most commonly affected?

A

Peripheral zone

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6
Q

80% of newly diagnosed prostate cancers are what?

A

Localised

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7
Q

How are most prostate cancer cases diagnosed

A

Incidentally through opportunistic PSA testing as most patients are asymptomatic

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8
Q

At present, is there a screening programme for prostate cancer?

A

No

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9
Q

What is the PSA test

A

A blood test to help detect prostate cancer - it’s not completely reliable though.

It’s prostate specific but not necessarily cancer-specific

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10
Q

What triad of tests are used in the diagnosis of prostate cancer?

A

PSA test

Digital rectal examination (rectal exam)

TRUS-guided prostate biopsies

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11
Q

Symptoms of local invasive disease associated with prostate cancer

A

Haematuria
Perineal and suprapubic pain
Impotence - can’t get an erection or orgasm
Incontinence
Loin pain or anuria - obstruction of ureters
Symptoms of renal failure
Haemospermia - blood in semen

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12
Q

Symptoms of metastatic prostate cancer

A

Bone pain or sciatica

Paraplegia secondary to spinal cord compression

Lymph node enlargement

Lymphoedema - particularly in lower limbs

Loin pain or anuria due to obstruction of the ureters by lymph nodes

Widespread metastases - lethargy, weight loss and cachexia

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13
Q

Why can screening be detrimental?

A

It leads to over-diagnosis and over-treatment of harmless cancers

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14
Q

How can under-treatment of aggressive cancers (like prostate cancer) be avoided?

A

Ad-hoc PSA testing

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15
Q

What does the PSA test detect?

A

Prostate specific antigen

It’s produced by glands of the prostate - may leak into the serum

Levels in serum increase with age

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16
Q

What is the normal range of Kallikrein serine protease in serum?

A

0-4.0 ug/ml

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17
Q

When might you expect to see an elevation in PSA (6)

A 
UTI 
Chronic prostatitis
Instrumentation - catheterisation
Physiological - ejaculation
BPH - enlarged prostate
Prostate cancer
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18
Q

What is the probability of cancer in relation to levels of PSA?

A 
0-1.0 = 5%
2.5-4.0 = 25%
>10 = 70%
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19
Q

What is the name given to the grading score for prostate cancer

A

Gleason grading of prostate cancer

score 3-5 (well to poorly differentiated)

Useful prognostically and guides treatment

Summated to give Gleason SUM core

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20
Q

How does the ISUP grade group work?

A

Grades prostate cancer from 1-5

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21
Q

For purposes of treatment and prognosis prostate cancer is divided into 4 stages, what are they?

A

Localised stage
Locally advanced stage
Metastatic stage
Hormone refractory stage - no longer responds to hormone therapy

22
Q

What investigations/imaging can be done to stage localised prostate cancer?

A

Digital rectal examination (local staging)

PSA

Transrectal US guided biopsies

CT (regional and distant staging)

MRI (local staging)

23
Q

Treatment options for localised prostate cancer?

A

Watchful waiting

Radiotherapy

Radical prostatectomy

Cryotherpay, thermotherapy

24
Q

Treatment of locally advanced prostate cancer

A

Watchful waiting

Hormone therapy followed by surgery

Hormone therapy followed by radiation

Hormone therapy alone

Intermitted hormone therapy (clinical research)

25
Q

Types of hormonal therapy for prostate cancer

A

Anti-androgens

Oestrogens

Chemical castration

26
Q

PSA levels in localised, locally advanced and metastatic disease

A

Localised - <20
Locally advanced - 20-100
Metastatic - >100

27
Q

What is the prognosis for metastatic prostate cancer

A

Median survival 3-5 years

28
Q

Recommended treatment for low-risk localised disease

A

Active surveillance
Surgery
EBRT
Brachytherapy

29
Q

Recommended treatment for intermediate risk localised disease

A

Surgery with external beam radiotherapy (EBRT) +/- HT

Brachytherapy

30
Q

What is Brachytherapy?

A

A form of radiotherapy where a sealed radiation source is placed inside or next to the area requiring treatment.

Localised treatment

31
Q

Recommended treatment for high-risk localised disease

A

External beam radiation therapy (EBRT) + HT

32
Q

Presentation of testicular cancer?

A

Usually a painless lump

Can sometimes have tender inflamed swelling, history of trauma (although this is not a RF)

33
Q

LUTS associated with localised disease in prostate cancer

A

Hesitancy

Frequency/urgency

weak/ poor stream

Straining

Dribbling

Nocturia

34
Q

Where does prostate cancer most often spread to in metastases?

A

Bone

Lymph nodes

35
Q

What is one of the most common cancers in young men?

A

Testicular cancer

36
Q

When is a man’s risk of testicular cancer higher?

A 
Testicular maldescent
Infertility 
Atrophic testis
Previous cancer in contralateral testis
Caucasian men
37
Q

What is a precursor lesion of testicular cancer?

A

Testicular Germ Cell Neoplasia In-Situ is a precursor lesion

38
Q

Types of tumour markers in testicular cancer? (3)

A

AFP (alpha-fetoprotein) (teratoma)

Beta-HCG (Human Chorionic Gonadotrophin) (seminoma)

LDH (Lactate dehydrogenase) (non-specific marker of tumour burden)

39
Q

How is testicular cancer diagnosed?

A

A lump in the testes is considered a tumour until proven otherwise

MSSU
Testicular USS and CXR
Tumour markers - blood test

40
Q

Differential diagnoses for a lump in the testes

A

Infection

Epididymal cyst

Missed testicular torsion

41
Q

Treatment of Testicular cancer

A

Radical orchidectomy is essential - removal of testes

Occasionally may need biopsy of ‘normal’ contralateral testis if high risk for tumour

Further treatment depends on tumour type, stage (TNM) and grade

42
Q

Types of testicular cancer

A

Germ cell tumour (GCT) - 95%

Non GCT - 5%

43
Q

Classes of GCT

A

Seminomatous GCT (classical, spermatocytic, or anaplastic) - mainly affects 30-40 y/o

Non-seminomatous GCT (teratoma, yolk sac, choriocarcinoma, mixed GCT) - mainly affects 20-30 y/o

44
Q

Types of Non-GCT (sex cord/stromal)

A

Leydig
Sertoli
Lymphoma rare

45
Q

Testicular cancer - grading (aggressiveness)

A

Based on histological assessment of differentiation

Low grade = well differentiated

High grade = poorly differentiated

46
Q

Testicular cancer - staging (spread)

A

Stage using TNM system. Tumour markers also provide staging and prognostic information

Spread occurs in 3 ways:
- local spread (i.e. local invasion to adjacent structures - pathological assessment)

  • Regional spread (lymphatic invasion - CT scan)
  • Distant spread (Lungs, bone, liver) using CT
47
Q

Stages of testicular cancer

A

Stage I - disease is confined to the testis

Stage II - Infradiaphragmatic nodes involved

Stage III - Supradiaphragmatic nodes involved

Stage IV - extralymphatic disease

48
Q

Treatment of low stage testicular cancer with negative markers

A

Orchidectomy, followed by:

Surveillance; or
Adjuvant radiotherapy (SGCT only); or
Prophylactic chemotherapy

49
Q

Treatment of nodal stage of testicular cancer with persistent tumour markers or relapse on surveillance

A

Combination chemotherapy (BEP - 3 drugs)
or
Lymph node dissection (NSGCT only)

50
Q

Treatment of metastases associated with testicular cancer

A

First-line chemotherapy

Second-line chemotherapy

51
Q

What is the prognosis of testicular cancer like?

A

Good if treated

Stage 1 - 5 year survival - 99%

Stage 4 - 5 year survival = 73%

2ND YEAR SYSTEMS: Urinary (25 decks)

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