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Year 2- Urinary > Tumours of the Urinary System > Flashcards

Tumours of the Urinary System Flashcards

1
Q

What is the most common cancer diagnosed in med?

A

Prostate cancer

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2
Q

In blood tests, what is looked at specifically regarding prostate cancer?

A

PSA
-> prostate specific antigen

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3
Q

Generally, what is the prognosis of prostate cancer like?

A

Very good

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4
Q

What are some of the risk factors for prostate cancer?

A

Increasing age
Family history
Race/ethnicity
Georgaphy
Obesity
Diet

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5
Q

Which race/ethnicity is most at risk of prostate cancer?

A

African/Afro-Caribbean have highest risk
Caucasian have moderate risk
East Asian have lowest risk

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6
Q

Family history of which syndrome increases risks of prostate cancer?

A

Lynch syndrome

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7
Q

What % of prostate cancers can be palpated via the rectum?

A

80%

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8
Q

Which zone of the prostate do most prostate cancers occur?

A

Peripheral zone

P=P

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8
Q

RECAP- name the four zones of the prostate

A

Transition zone
Central zone
Peripheral zone
Anterior fibromuscular stroma

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9
Q

What is important to note about the symptoms of prostate cancers?

A

Often asymptomatic and do not present with usual cancer symptoms e.g. weight loss

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10
Q

How is prostate cancer diagnosed?

A

Opportunistic ad hoc PSA testing

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11
Q

What is important to note about PSA elevation?

A

Whilst PSA is prostate specific, it is not cancer specific, so when raised, it’s not always cancer

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12
Q

When else may PSA be raised apart from prostate cancer?

A

BPE (benign prostate enlargement)
Infection

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13
Q

What are the symptoms of localised prostate cancer?

A

Trick question, if it’s localised, there will be no symptoms

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14
Q

What are some of the symptoms of distant metastases from metastatic prostate cancer?

A

Bone pain or sciatica
Paraplegia secondary to spinal cord compression
Lymph node enlargement
Loin pain or anuria due to obstruction of ureters by lymph nodes

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15
Q

What are some of the symptoms of widespread metastases from metastatic prostate cancer?

A

Lethargy
Weight loss

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16
Q

What is the commonest mode of presentation for prostate cancer?

A

Asymptomatic - incidentally noted

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17
Q

What is important to note about normal serum range for PSA?

A

It increases with age because of BPH

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18
Q

What is the normal PSA for those who are <50?

A

2.5 upper limit

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19
Q

What is the normal PSA for those who are 50-60?

A

3.5 upper limit

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20
Q

What is the normal PSA for those who are 60-70?

A

4.5 upper limit

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21
Q

What is the normal PSA for those who are >70?

A

6.5 upper limit

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22
Q

What can be done to differentiate between transient and persistent rise in PSA?

A

Recheck PSA in at least 3 weeks

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23
Q

How long is the half-life of PSA?

A

2.2 days

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24
Q

List some causes of transient causes of elevated PSA.

A

UTI
Chronic prostatitis
Instrumental e.g. catheterisation
Physiological e.g. ejaculation
Recent urological procedure

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25
Q

List some causes of persistent causes of elevated PSA.

A

BPH
Prostate cancer

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26
Q

Okay, so, if a GP checks bloods of a man and the PSA is elevated, what should they do?

A

Not worry and recheck in 3 weeks
If still raised, it’s a persistent rise

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27
Q

How is a diagnosis of prostate cancer most commonly made?

A

Usually due to a rise in age-specific PSA
Abnormal prostate on digital rectal examination

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28
Q

If prostate cancer is suspected, what is done to confirm?

A

Pre-biopsy prostate multiparametric MRI to identify the area of interest to biopsy
Biopsy then carried out

->important to note that MRI does not actually diagnosis but gives information relating to diagnosis. Can also be used for staging of prostate cancer

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29
Q

Basically just give a wee summary pf the steps of a prostate cancer diagnosis pls x

A

Serum PSA
Digital rectal examination
Pre-biopsy MRI
Biopsy
Additional staging for metastasis if required e.g. bone scan

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30
Q

What is meant by ad hoc PSA testing?

A

Testing PSA level in men who are worried about prostate cancer or who have family history, not testing every man once he reaches a certain age like breast screening

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31
Q

What is meant by the grading of cancer?

A

Assessment of the aggression of the cancer

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32
Q

What is meant by staging of cancer?

A

Assessment of the spread of cancer

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33
Q

What is grading of prostate cancer based on?

A

Gleason sum score

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34
Q

What is used for the staging of cancer?

A

TMN staging system

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35
Q

How is a Gleason Sum Score given?

A

Score of 3-5 given looking at the largest area
Score of 3-5 given looking at the second largest area

Two numbers added to give the total sum score

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36
Q

What is the commonest organ that prostate cancer spreads to?

A

Bone

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37
Q

For the purposes of treatment and prognosis, prostate cancer is divided into 4 clinical stages. What are they?

A

Localised stage
Locally advanced stage
Metastatic stage
Castrate-resistant/Hormone-refractory stage

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38
Q

What is the treatment for localised prostate cancer?

A

Watchful waiting
Radiotherapy
Radical prostatectomy

39
Q

What is the treatment for locally advanced prostate cancer?

A

Watchful waiting
Hormone therapy followed by surgery
Hormone therapy followed by radiation

40
Q

What does prostate cancer require to fuel it’s growth?

A

Testosterone

41
Q

The following are reasonable treatment options for low-risk localised prostate cancer EXCEPT:

a. external beam radiotherapy
b. active surveillance
c. brachytherapy
d. radical prostatectomy
e. radical chemotherapy

A

E- radical chemotherapy

->this is for advanced disease

42
Q

What is the presentation of testicular cancer?

A

Usually a painless lump

Can be tender, inflamed, swollen

43
Q

What decade is the peak incidence of testicular cancer?

A

3rd decade

(20-30)

44
Q

What are some of the risk factors for testicular cancer?

A

Undescended testis– 10 x risk
Infertility
Genetic abnormalities
Chromosomal abnormalities
Race- Caucasian

45
Q

Which syndrome increases risks of testicular cancer?

A

Klinefelter syndrome

46
Q

If there is a lump in the testis, it is considered to be a testicular tumour until proven otherwise. What are some differential diagnosis’?

A

Infection
Epidydimal cyst
Missed testicular torsion

47
Q

What tests should be considered for someone with a lump in the testis?

A

MSSU
STI screen
Tumour markers

48
Q

What is the most important imaging investigation in the diagnosis of testicular cancer?

A

Testicular ultrasound

49
Q

What are the three main tumour markers indicative of testicular cancer?

A

AFP
HCG
LDH

-> in 70% of testicular cancers, at least one will be abnormal

50
Q

For testicular cancer, the main lymphatic spread to regional lymph nodes occurs in which group of lymph nodes?

A

Para-aortic lymph nodes

51
Q

What is the treatment for testicular cancer?

A

Radical orchidectomy using an inguinal incision

52
Q

Why is biopsy of testicular mass not carried out?

A

Risk of tumour seedling across biopsy tract

53
Q

What type of tumour makes up 95% of testicular cancers?

A

Germ cell tumour

->other 5% are non-germ cell tumours

54
Q

What are the three ways testicular cancer can spread?

A

Local spread e.g. local invasion
Regional spread to para-aortic lymph nodes
Distant spread e.g. lungs, bone, liver

55
Q

Stage 1 testicular cancer?

A

Disease confined to testes

56
Q

Stage 2 testicular cancer?

A

Infra-diaphragmatic para-aortic lymph nodes involved

57
Q

Stage 3 testicular cancer?

A

Supra-diaphragmatic para-aortic lymph nodes involved

58
Q

Stage 4 testicular cancer?

A

Extra-lymphatic disease involving solid organs e.g. lungs, liver and bone

59
Q

What is the treatment for metastatic testicular cancer?

A

Chemotherapy

60
Q

What are urothelial tumours?

A

Malignant tumours of the lining transitional cell epithelium which can occur at any point in the urinary tract

61
Q

Where is the most common site for urothelial tumours?

A

Bladder-90%

62
Q

What is the usual tumour type of bladder cancer?

A

Transitional cell carcinoma

63
Q

In countries where schistosomiasis is endemic, e.g. Sub-Saharan Africam what is the most common tumour of the bladder?

A

Squamous cell carcinoma

64
Q

What are some risk factors for transitional cell carcinoma?

A

Smoking
Aromatic amines
Non-hereditary genetic abnormalities

65
Q

What are some of the risks factors for squamous cell carcinoma?

A

Schistosomiasis
Chronic cystitis
Cyclophosphamide therapy
Pelvic radiotherapy

66
Q

What is the most common presenting feature of bladder cancer?

A

Painless visible haematuria

67
Q

What are some other presenting features of bladder cancer?

A

Recurrent UTI’s
Storage bladder symptoms e.g. dysuria, frequency, urgency, incontinence
Bladder pain

68
Q

What is the first step if a patient presents with haematuria?

A

Urine culture to rule out infection

69
Q

What other investigations are used to investigate haematuria?

A

Upper tract imaging e.g. ultrasound for kidneys, CT urogram for ureters

Urine cytology

BP, U&E’s

70
Q

Above what age is frank haematuria suggestive of nalignancy?

A

> 50

71
Q

If someone above 50 has frank haematuria, what should be done?

A

Flexible cystourethroscopy within two weeks
IVU and ultrasound

72
Q

In a patient over 50 with microscopic haematuria, what should be done next?

A

Flexible cystourethroscopy within 4-6wks
Ultrasound

73
Q

What is meant by carcinoma is situ?

A

Cells at the base of the membrane have changed their appearance but are not truly invading yet

74
Q

If a bladder cancer was given the stage Ta, what does this mean?

A

Cancer is superficial and does not invade the lamina propria

75
Q

If a bladder cancer was given the stage T1, what does this mean?

A

Cancer is through the lamina propria but not invading the detrusor muscle

76
Q

If a bladder cancer was given the stage T2, what does this mean?

A

Cancer going into detrusor muscle

77
Q

If a bladder cancer was given the stage T3, what does this mean?

A

Cancer spreading more though detrusor muscle

78
Q

If a bladder cancer was given the stage T4, what does this mean?

A

Bladder cancer is spreading to other organs

79
Q

What is the treatment for bladder cancer if it is low grade and non-muscle invasive?

A

Endoscopic resection followed by single instillation of chemotherapy

80
Q

What is the treatment for bladder cancer if it is high grade and non-muscle invasive?

A

Intravesical BCG

->Endoscopic resection alone not sufficient
BCG is same as vaccine for TB as allows bladder to fight it’s own cancer

81
Q

What is the treatment for muscle invasive bladder cancer?

A

Neoadjuvant chemotherapy followed by radical radiotherapy and/or radical cystoprostatectomy in men and hysterectomy in women

82
Q

What is the prognosis like for:

a. non-invasive low-grade bladder cancer
b. invasive, high-grade bladder cancer

A

a. 90% 5yr survival
b. 50% 5yr survival

83
Q

What are the symptoms of upper tract urothelial cancers?

A

Frank haematuria
Unilateral ureteric obstruction
Flank or loin pain

84
Q

What are the diagnostic investigations for upper tract urothelial cancers?

A

CT-IVU or IVU
Urine cytology
Ureteroscopy and biopsy

85
Q

Where is the commonest site for upper tract urothelial cancers?

A

Renal pelvis or collecting system

86
Q

Name two types of benign renal cancers.

A

Oncocytoma
Angiomyolipoma

87
Q

What is the most common malignant renal tumour

A

Renal carcinoma

88
Q

Where do most renal adenocarcinomas arise from?

A

Proximal tubules

89
Q

What are some of the risk factors for renal adenocarcinoma?

A

Family history
Smoking
Anti-hypertensive medication
Obesity
End-stage renal failure
Acquired renal cystic disease

90
Q

What is the presentation of renal adenocarcinoma?

A

50% asymptomatic

10% classic triad of flank pain, mass and haematuria

91
Q

How can renal adenocarcinomas spread?

A

Direct invasion through the renal capsule
Venous invasion to renal vein and vena cava

92
Q

Where can hematogenous spread of renal adenocarcinoma spread to?

A

Lungs and bone most commonly

93
Q

What investigations are used in renal adenocarcinomas?

A

CT scan of abdomen and chest mandatory
Bloods; U&E’s, FBC

94
Q

What is the treatment of renal adenocarcinoma?

A

Surgery- radical nephrectomy

Year 2- Urinary (22 decks)

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