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Renal / Urology > Tumours of the Urinary System > Flashcards

Tumours of the Urinary System Flashcards

1
Q

What can urothelial / transition cell cancer affect

A

Bladder (90%)
Ureter
Renal pelvic
Collecting system

ALL TCC

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2
Q

What is the most common bladder cancer

A

Transitional cell carcinoma

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3
Q

What is associated with TCC

A 
Age 
Smoking 
Aromatic amines - hair dye / industrial paint - ask occupational hx 
Cyclophosphamide 
Genetics - p53 + Rb
Chron's 
Renal transplant
Obesity
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4
Q

What other cancers can affect the bladder

A

SCC

Adeno <1%

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5
Q

What is associated with SCC

A 
Schistosomiasis 
Staghorn calculi 
Smoking 
Chronic cystitis from UTI / stone / catheter 
Pelvic RT
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6
Q

A person with vasculitis + haematuria

A

Investigate for bladder TCC as likely treat with cyclophosphamide

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7
Q

What is the grade of bladder cancer

A

Grade 1 = well differentiated, non-invasive
Grade 2 = moderate, non invasive
Grade 3 = poorly differentiated, invasive

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8
Q

What is CIS

A

Non invasive

Aggressive so high risk

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9
Q

What is Tis, T1

A

Non-invasive

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10
Q

What is T2 and >

A

Invades detrusor muscle

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11
Q

What are the symptoms of bladder TCC

A 
Painless visible haematuria = most common 
Weight loss
Recurrent UTI
Bladder pain
Voiding irritability 
Storage Sx if tumour big enough 
- Dysuria
- Frequency
- Nocturia 
Urge incontinence
May present as obstruction in acute urinary retention
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12
Q

Where does bladder cancer spread too

A

Local to pelvic
Para aortic and iliac nodes
Blood to liver and lungs
Bone = pain and hypercalcaemia

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13
Q

What can a bladder mass do

A

Obstruct ureter
Hydronephrosis
Nephrotic syndrome / renal failure

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14
Q

What do you do for unexplained non visible haematuria + no other sx

A

Refer <2 weeks for rigid cystourethroscopy + biopsy if frank and 4 weeks if microscopic

If
>50
RF
FH

Can do urine cytology as non-invasive test and will show malignant cells = 1st line

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15
Q

What other investigations for haematuria

A

Dipstick + MSSU to exclude infection
Bloods incl U+E
Urine cytology
Renal USS

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16
Q

How do you Dx and grade bladder cancer

A

TURBT - cystoscopy and resect including detrusor
EUA - biopsy
Flurosecent cystoscopy
Urine cytology can be useful in high grade as non-invasive and shows malignant cells

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17
Q

How do you stage

A

CTU to stage
MRI - pelvic node
Bone scan

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18
Q

How do you treat low grade non invasive

A

TURBT
Intravesicle chemo into bladder
Regular BCG vaccine into bladder
Most are this as people present with haematuria

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19
Q

How do you follow up

A

High risk of recurrence
Regular cystoscopy every 3 months for 2 years
Intense follow up

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20
Q

How do you treat high grade non invasive

A

50-80% will become invasive
Immunotherapy
Radical surgery - cystectomy with ideal conduit
Neoadjuvant chemo

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21
Q

How can high grade present

A

May appear like infection with no mass

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22
Q

How do you treat muscle invasive

A 
Radical cystectomy = gold standard
Chemotherapy - Neo and adjuvant
Radical RT
Cystoprostatectomy in men 
Anterior pelvic exenteration + urethrectomy in women
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23
Q

How do you treat T4

A

Palliative chemo / RT

Long term catheter

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24
Q

What are complications of cystectomy

A

Sexual and urinary malfunction
Bladder haemorrhage - disease or surgery
Increased risk of adenocarcinoma due to bowel being used in reconstruction

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25
Q

What can you do for advanced disease with intractable haematuria

A

Alum solution bladder irrigation
If no renal failure
But intractable haematuria

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26
Q

Where else can TCC affect

A

Renal pelvis = common

Ureter

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27
Q

How does Upper tract TCC present

A

Frank haematuria
Unilateral ureteric obstruction
Flank or loin pain
Met symptoms

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28
Q

What are symptoms of mets

A

Bone pain
Hypercalcaemia
Lung
Brain

29
Q

How do you investigate upper tract TCC

A 
Haematruia investigation
CTU
Urine cytology
Ureteroscopy + biopsy = diagnostic
CT / MRI to stage
30
Q

How do you treat

A

NEPHROURETERECTOMY

31
Q

What do you do if unfitt for surgery

A

Ureterscopic laser ablation
Surveillance
Endoscopic if univocal and low grad

32
Q

What is the risk of upper tract TCC

A

High risk of bladder TCC

40% over 10 years

33
Q

What type of cancer is renal cell carcinoma

A

Adenocarcinoma
15% TCC
Wilms in children

34
Q

What are benign cancer

A

Oncocytoma

Angiomyolipoma - associated TS

35
Q

What are adenocarcinoma

A 
Clear cell = 85%
Papillary
Hydronephroma
Grawitz
Wilm's in children
36
Q

What is the classic triad of renal cell carcinoma

A

Flank pain
Abdo mass
Haematuria

37
Q

What are parneoplastic symptoms

A 
PUO
Anorexia
Malaise
Weight loss
Hypertension
Hypercalcaemia
Polycythaemia 
L varicocele
Hepatic dysfunction - LFT / cholestasis 
Renal vein thrombosis
38
Q

What causes hypertension

A

Renin secretion

39
Q

What causes hypercalcaemia

A

PTH secretion

40
Q

What causes polycythaemia

A

Erythropoeitin secretion

41
Q

What causes L varicocele

A

Renal vein compressing testicular
Testicular drains into renal so if renal blocks then varicocele forms
Do renal USS if patient presents

42
Q

Metastatic spread of renal cell carcinoma (25% at presentation)

A 
Direct into posts / bowel / renal vein / adrenal
Haematogenous
Lymphatic - para-caval
Lungs - cannon ball met = haemoptysis 
Bone
Brain
Liver
43
Q

What are investigations for RCC

A 
Haematuria
Bloods- FBC, U+E, ALP
Bone profile for mets 
Urine cytology 
Renal tract USS
CXR for lung
44
Q

What is diagnostic

A

CT scan CAP and KUB

Look for vascular invasion

45
Q

When would you do bone scan

A

If symptoms

46
Q

When would you do biopsy

A

If ablation planned

47
Q

Why ALP

A

Bone mets

48
Q

What are other options

A

USS
CTU
DMSA / MAG-3 for function

49
Q

What should you always do

A

Assess contralateral kidney and testis

50
Q

How do you treat

A

Radical nephrectomy
Curative if
+- RT / chemo

51
Q

What do you do if unfit

A

Cyrotherapy
Radiofrequency ablation
Watch and wait

52
Q

What predicts survival

A

Mayo Prognostic Risk Score

53
Q

How do you treat mets / advanced disease

A 
Immunotherapy as chemo and RT resistant - interleukin / interferon 
Tyrosine kinase inhibtor
Targeted therapy against VEGF 
Surgery = not an option 
Palliative = only option
54
Q

How does renal vein thrombosis present

A

Haematuria
Loin pain
High creatinine and Hb

55
Q

What is T1

A

<7cm and confined

56
Q

What is T2

A

> 7cm and confined

57
Q

What is T3

A

Local extension outside capsule - invades renal vein / IVC / LN

58
Q

What is T4

A

Invades beyond Great fascia

59
Q

What is common renal malignancy in children

A

Nephroblastoma

60
Q

How does it present

A

Mass
Haematuria
Early lung mets

61
Q

What are RF for Renal cell cancer

A 
Age 
Male 
FH
Smoking
DM
Obesity
Hypertension
ESRF / dialysis 
Polycystic kidney 
Tuberous sclerosis
VHL
62
Q

What suggests poor prognosis in renal cancer

A

Poor performance status
Hb 1.5x
Calcium high
Presence of liver / lung / retroperitoneal LN

63
Q

Anatomy kidney

A 
Retroperitoneal 
T12-L3 
L higher than R
Renal artery of AA - L1/2
Renal vein to IVC
Para-aortic node
64
Q

Why do hydroceles occur on the L

A

L renal vein has to stretch over as IVC on the R side

65
Q

Anatomy of ureter

A 
Comes out renal pelvic (
Travels on anterior surface of psoas 
Transitional epithelium 
Crosses pelvic brim at sacroiliac joint to enter pelvic (PUJ) 
Enters blader at VUJ
66
Q

What is water under bridge

A

Ureter (water) i posterior to uterine artery (bridge) in F and vas deferens in M
IMPORTANT FOR SURGERY
Don’t want to clip

67
Q

Anatomy of bladder

A

Continuaion of TCC

68
Q

vHL

A

AD
RCC
Phaeochromocytoma
Haemangioblastoma

Renal / Urology (16 decks)

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