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Year 2 Urinary (JK) > Tumours of the urinary system 2 - urothelial and renal > Flashcards

Tumours of the urinary system 2 - urothelial and renal Flashcards

1
Q

What are urothelial cancers?

A

Malignant tumours of the lining transitional cell epithelium (uroepithelium) which occurs at any point of the urinary tract

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2
Q

Where is the most common site of urothelial cancers?

A

bladder - 90%

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3
Q

Most common bladder cancer cell type

A

TCC

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4
Q

When is TCC not the most common type of bladder cancer?

A

where schistosomiasis is endemic - squamous cell carcinoma

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5
Q

TCC risk factors (most common?)

A

SMOKING
aromatic amines
non-hereditary genetic abnormalities

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6
Q

SCC risk factors

A

schistosomiasis!
chronic cystitis
pelvic radiotherapy
cyclophosphamide therapy

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7
Q

Most common presenting symptom of bladder cancer

A

frank haematuria

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8
Q

Other ways bladder cancer can present

A

occasionally due to invasive/mets

others eg recurrent UTI, storage LUTS

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9
Q

What are the storage bladder symptoms?

A

dysuria, frequency, nocturia, ugency +/- urge incontinence

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10
Q

If LUTS are the presenting symptom of bladder cancer what should you expect?

A

carcinoma in situ

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11
Q

5 investigations of haematuria

A 
urine culture - majority of painful haematuria due to UTI
cystoscopy 
urine cytology 
CTU or USS 
Blood pressure and U+E's
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12
Q

What is the % risk of malignancy with frank haematuria?

A

25-35%

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13
Q

Risk of malignancy with dipstick/microscopic haematuria?

A

5-10%

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14
Q

What are the drawbacks with IVU and USS alone?

A

IVU miss renal cell tumours <3cm

USS miss some urothelial tumours of upper tract

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15
Q

How is bladder cancer diagnosed? What information does this give?

A

cystoscopy and TURBT - endoscopic resection

grade and T stage

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16
Q

How is TNM staging of bladder cancer done?

A

CT, MRI
bone scan if symptomatic
CTU for upper tract TCC

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17
Q

What does T stage of bladder cancer tell us?

A

superficial or muscle invasive

18
Q

Grades of bladder cancer

A

G1 - well diff
G2 - mid diff
G3 - poorly diff
CIS - very aggressive and non muscle invasive

19
Q

4 things treatment of bladder cancer depends on

A

site
stage
histological grade
age and co morbidities of patient

20
Q

Treatment of low grade non muscle invasive bladder cancer

A

endoscopic resection and intravesical chemotherapy which can both be prolonged and endoscopic follow up

21
Q

Treatment of high grade non muscle invasive or CIS bladder cancer

A

endoscopic resection alone insufficient
BCG therapy if CIS
if BCG not working - radical surgery

22
Q

Muscle invasive bladder cancer treatment

A

neoadjuvant chemotherapy
radical radiotherapy and/or radical cystoprostatectomy
urinary diversion and lymphadenectomy

23
Q

6 factors prognosis of bladder cancer is dependent on

A 
size 
stage 
grade 
multifocality 
recurrence in 3 months 
presence of concurrent CIS
24
Q

Main symptoms of upper tract urothelial cancer

A

frank haematuria
loin/flank pain
ureteric obstruction
symptoms of nodal or mets eg bone pain

25
Q

Diagnosis of upper tract urothelial cancer

A

CT IVU or IVU
urine cytology
ureteroscopy and biopsy

26
Q

Where is TCC of upper tract usually found and describe it briefly

A

very aggressive - high grade and multifocal
renal pelvis or collecting system
high risk of local recurrence
high risk of bladder TCC

27
Q

How is TCC of upper tract treated? exceptions.

A

nephro-ureterectomy

unfit or bilateral disease requires endoscopic treatment

28
Q

2 benign renal tumours

A

oncocytoma

angiomyolipoma

29
Q

Malignant renal tumour main type

A

renal adenocarcinoma

30
Q

What part of the kidney do most renal adenocarcinomas arise?

A

proximal tubules

31
Q

4 subtypes of renal adenocarcinoma and the main one

A

CLEAR CELL
papillary
chromophobe
bellini type ductal carcinoma

32
Q

Risk factors of renal adenocarcinoma

A 
FH
smoking 
obesity 
anti-hypertensive medications 
ESRD
acquired renal cystic disease
33
Q

How do most renal tumours present?

A

asymptomatic

34
Q

Other ways in which renal tumours present

A

mets symptoms
TRIAD = loin pain, haematuria, mass
paraneoplatic syndrome

35
Q

What T stage of renal disease is the first which goes beyond the capsule?

A

3

36
Q

How can renal adenocarcinoma spread?

A

direct spread - through renal capsule
venous invasion - renal vein and IVC
haematogenous spread to lungs and bones
lymphatic spread to paracaval nodes

37
Q

Investigations of renal adenocarcinoma

A

CT scan abdomen and chest
bloods - U+Es and FBC
optional eg IVU, uss, dmsa, mag-3

38
Q

Treatment of renal adenocarcinoma

A

surgical - laprascopic radical nephrectomy

39
Q

Why is metastases treatment of renal adenocarcinoma so difficult?

A

RCC is chemo and radio RESISTANT

40
Q

Other treatments for renal adenocarcinoma

A

targeted receptor tyrosine kinase inhibitors

immunotherapy

Year 2 Urinary (JK) (26 decks)

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