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Renal > Tumours of the Urinary System 2 (Bladder and Renal Cancer) > Flashcards

Tumours of the Urinary System 2 (Bladder and Renal Cancer) Flashcards

1
Q

Where can urothelial cancer occur? What is the most common site?

A

At any point along the transitional cell epithelium, from renal calyces to the tip of the urethra

  • Most common site is bladder: 90% of cases
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2
Q

What is the most common type of bladder cancer?

A
  • Transitional cell carcinoma (TCC)
  • Where Schistosomiasis (infection from parasitic worm) is endemic, squamous cell carcinoma (SCC) of the bladder is most common type (Africa, South America, the Caribbean, the Middle East and Asia)
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3
Q

What are the risk factors for transitional cell carcinoma of the bladder?

A
  • Smoking (accounts for 40%)
  • Aromatic amines
  • Genetics (TSG, p53, Rb)
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4
Q

What are the risk factors for squamous cell carcinoma of the bladder?

A
  • Schistosomiasis (S. haematobium only)
  • Chronic cystitis
  • Cyclophosphamide therapy
  • Pelvic radiotherapy
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5
Q

How does bladder cancer tend to present?

A
  • Painless visible haematuria (frank or microscopic)
  • Metastatic symptoms
  • Recurrent UTI
  • Storage symptoms: dysuria, frequency, urgency, incontinence
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6
Q

What is frank haematuria? What is microscopic haematuria?

A
  • Frank: reported by patient

- Microscopic: detected by doctor / tests

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7
Q

What investigations should be performed on haematuria that suggests bladder cancer?

A
  • Urine culture (rule out UTI)
  • CT urogram / USS
  • Cystourethroscopy (visualize the urethra & bladder)
  • Urine cytology
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8
Q

What is the risk of malignancy with Frank haematuria? What are some investigations when the patient cites Frank haematuria?

A
  • If >50yrs risk of malignancy is 25-35%
  • Flexible cystourethroscopy within 2 weeks
  • CT urogram and USS
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9
Q

What is the risk of malignancy with microscopic haematuria? What are some investigations when microscopic haematuria is seen?

A

If >50yrs risk of malignancy is 5-10%

  • Flexible cystourethroscopy within 4-6 weeks
  • USS
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10
Q

What investigations are used for staging of bladder cancer?

A

cross-sectional imaging (CT, MRI)

Bone scan if symptomatic

CT Urography for upper tract TCC

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11
Q

What is the main surgical treatment for bladder cancer?

A

TURBT

Trans-urethral resection of bladder tumour

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12
Q

What is the main test for diagnosis of bladder cancer? Why?

A

Cystoscopy / Fluourescent Cystoscopy

  • A cystoscopy is a procedure to look inside the bladder using a thin camera called a cystoscope
  • Why: permits biopsy and resection of papillary tumours
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13
Q

How are bladder tumours classified?

A 
Graded & Staged (TNM staging)
Grades:
- G1 = Well diff. - commonly non-invasive
- G2 = Mod. diff. - often non-invasive
- G3 = Poorly diff. - often invasive
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14
Q

What are the usual treatment plans for low grade non-muscle invasive tumours (Ta & T1) and high grade non-muscle invasive tumours of the bladder?

A
  • Low grade: endoscopic resection followed by single instillation of intravesical chemotherapy within 24 hours
  • High grade: Endoscopic resection plus intravesical BCG therapy (maintenance course, weekly for 3 weeks repeated 6 monthly over 3 years)
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15
Q

What is the usual treatment plan for muscle invasive tumours of the bladder? (T2 & T3)

A
  1. Neoadjuvant chemotherapy
  2. radical cystoprostatectomy (men) or anterior pelvic exenteration with urethrectomy (women)
  3. Urinary Diversion (eg. ileal conduit / catheterizable stoma)
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16
Q

What is the prognosis for bladder cancer like?

A

Non-invasive, low grade bladder TCC: 90% 5-year survival

Invasive, high grade bladder TCC: 50% 5-year survival

17
Q

Where do upper tract urothelial cancers tend to occur? What is the most common type?

A
  • in the ureter, renal pelvis & collecting system

- TCC

18
Q

What are the main signs / symptoms of upper tract urothelial cancer?

A
  • Frank haematuria
  • Unilateral ureteric obstruction
  • Flank / loin pain
  • Metastatic symptoms
19
Q

What investigations should be done for suspected upper tract urothelial cancer? (UTUC)

A

CT-IVU or IVU (intravenous urogram)(show filling defect in renal pelvis)

Urine cytology

Ureteroscopy and biopsy

20
Q

What treatment options are available for upper tract urothelial cancer?

A
  • nephro-ureterectomy (minimally invasive surgical procedure to remove a patient’s renal pelvis, kidney, ureter, and bladder cuff)
  • ureteroscopic laser ablation (need regular uteroscopic surveillance afterwards)
21
Q

What are the two most common benign cancers of the kidneys?

A
  • oncocytoma

- angiomyolipoma

22
Q

What is the most common malignant cancer of the kidneys?

A
  • Renal adenocarcinoma

Four histological subtypes: clear cell (85%)
papillary (10%)
chromophobe (4%)
Bellini type ductal carcinoma (1%)

23
Q

What are some risk factors for renal adenocarcinoma?

A
  • Family history (genetics)
  • Smoking
  • Anti-hypertensive medications
  • Obesity
  • End stage renal failure
  • Acquired renal cystic disease
24
Q

How do renal adenocarcinomas tend to present?

A
  • Classic triad: flank pain, palpable mass, haematuria
  • 50% asymptomatic
  • Paraneoplastic syndromes: anorexia, pyrexia, cachexia (weakness / wasting), hypertension, hypercalcaemia
  • Metastatic disease
25
Q

What investigations should be done for suspected renal adenocarcinoma?

A
  • CT scan of abdomen & chest (staging & assesses contralateral kidney)
  • Bloods: FBC and U&E
  • USS
  • DMSA or MAG-3 renogram to assess split renal function if doubts about contralateral kidney
26
Q

Describe the T (in TNM) staging in regards to renal carcinoma

A

T1 - Tumour < 7cm confined within renal capsule
T2 - Tumour >7cm & confined within capsule
T3 - Local extension outside capsule
T3a - Into adrenal or peri-renal fat
T3b - Into renal vein or IVC below diaphragm
T3c - Tumour thrombus in IVC extends above diaphragm
T4 - Tumour invades beyond Gerota’s fascia (renal fascia)

27
Q

Which lymph nodes does renal adenocarcinoma tend to spread to first?

A
  • Paracaval nodes
28
Q

What are the treatment options for renal adenocarcinoma?

A
  • Laparoscopic radical nephrectomy: curative if < T2

- palliative cytoreductive nephrectomy for patients with metastatic disease, prolongs median survival 6 months

29
Q

When are radiotherapy and chemotherapy used to manage renal cell carcinoma?

A

RCC is radioresistant and chemoresistant

So not too often

30
Q

What are some newer therapies being used to treat renal cell carcinoma?

A
  • multitargeted receptor tyrosine kinase inhibitors (sunitinib, sorafenib, panzopanib)
  • Immunotherapy (Interferon alpha, Interleukin-1)
31
Q

What is the prognosis for renal adenocarcinoma?

A 
T1 – 95% 5-year survival
T2 – 90% 5-year survival
T3 – 60% 5-year survival
T4 – 20% 5-year survival
N1 or N2 – 20% 5-year survival
M1 – Median survival 12-18 months

Renal (30 decks)

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