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Urinary System > Tumours Of The Urinary System > Flashcards

Tumours Of The Urinary System Flashcards

1
Q

What are the common sites of urothelial tumours?

A

Most common site is bladder but can occur anywhere from renal calyces to the tip of the urethra

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2
Q

What are the types of bladder cancer?

A

90% transitional cell carcinoma

Squamous cell carcinoma can occur where schistosomiasis is endemic

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3
Q

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

A

Smoking
Aromatic amines (present in paint and dark hair dyes)
Non-hereditary genetic abnormalities

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4
Q

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

A

Schistosomiasis
Chronic cystitis
Cyclophosphamide therapy
Pelvic radiotherapy

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5
Q

What are the presenting symptoms of bladder cancer?

A

Most common presenting symptom is painless visible haematuria
Recurrent UTIs
Storage bladder problems- dysuria, frequency, bladder pain

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6
Q

How is haematuria investigates?

A

Urine culture
Upper tract imaging
Cystourethroscopy
Urine cytology

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7
Q

How is bladder cancer diagnosed?

A

Cystoscopy and endoscopic resection

Examination under anaesthetic to assess bladder mass/thickening before and after surgery

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8
Q

How is bladder cancer staging investigated?

A

Cross-sectional imaging (CT/MRI)
Bone scan if symptomatic
CTU for upper tract TCC

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9
Q

How is bladder cancer treated?

A

Endoscopic or radical

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10
Q

How is transitional cell carcinoma graded?

A

G1- well differentiated, non-invasive
G2- moderately differentiated, often non-invasive
G3- poorly differentiated, often invasive
Carcinoma in situ- non-muscle invasive but very aggressive

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11
Q

How is low grade non-muscle invasive bladder cancer treated?

A

Endoscopic resection followed by instillation of intravesical chemotherapy
Prolonged endoscopic follow up for moderate grade rumours
Consider prolonged course of intravesical chemotherapy

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12
Q

How is high grade non-muscle invasive bladder cancer treated?

A

CIS- consider intravesical BCG therapy

Radical surgery may be necessary

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13
Q

How is muscle invasive bladder cancer treated?

A

Neoadjuvant chemotherapy for local and systemic control, followed by:
Radical radiotherapy
Radical cystoprostatectomy
AND/OR
Radical surgery combined with urinary diversion

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14
Q

What is the prognosis of bladder cancer dependent on?

A 
Stage 
Grade 
Size 
Multifocality 
Presence of concurrent CIS
Recurrence at 3 months
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15
Q

What are the presenting factors of upper tract urothelial cancer?

A

Frank haematuria
Unilateral ureteric obstruction
Flank or loin pain

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16
Q

What are the symptoms of nodal or metastatic disease?

A

Bone pain
Hypercalcaemia
Lung symptoms
Brain symptoms

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17
Q

What are the diagnostic investigations for upper tract urothelial cancer?

A

CT-IVU or IVU- shows filling defect in renal pelvis
Urine cytology
Ureteroscopy and biopsy

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18
Q

Where is upper tract urothelial cancer most common?

A

In the renal pelvis or collecting system

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19
Q

How is upper tract urothelial cancer treated?

A

Most TCC’s treated with nephro-ureterectomy
If unfit or has bilateral disease, nephron sparing endoscopic treatment
If unifocal and low grade- relative indication for endoscopic treatment

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20
Q

What are the different kinds of renal tumour?

A

Benign- oncocytoma, angiomyolipoma

Malignant- renal adenocarcinoma

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21
Q

What are the risk factors for renal adenocarcinoma?

A 
Family history 
Smoking 
Anti-hypertensive medication 
Obesity
End-stage renal failure 
Acquired renal cystic disease
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22
Q

How does renal adenocarcinoma present?

A

~50% asymptomatic
Classic triad- flank pain, mass and haematuria
Paraneoplastic syndrome- anorexia, cachexia, pyrexia, hypertension, hypercalcemia, abnormal LFTs, anaemia, polycythaemia and raised ESR
Metastatic symptoms

23
Q

Where are the common sites for metastases of renal adenocarcinoma?

A

Bone
Brain
Lungs
Liver

24
Q

How is renal cancer staged?

A

T1- tumour <7cm and confined within renal capsule
T2- tumour >7cm and confined within renal 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

25
Q

What are the mechanisms for spread of renal adenocarcinoma?

A

Direct spread through the renal capsule
Venous invasion to renal vein and vena cava
Haematogenous spread to lungs and bone
Lymphatic spread to paracaval nodes

26
Q

How is renal adenocarcinoma investigated?

A

CT scan of abdomen and Chest
Bloods- U&E, FBC
Optional:
- ultrasound can differentiate tumour from cyst

27
Q

How is renal adenocarcinoma treated?

A

Surgically- radical nephrectomy

28
Q

How can metastatic renal adenocarcinoma he managed?

A

Palliative cytoreductive nephrectomy
Little treatment as RCC is radioresistant and chemoresistant
Can give multitargeted receptor tyrosine kinase inhibitors or immunotherapy

29
Q

What are the risk factors for prostate cancer?

A 
Age
Race/ethnicity
Geography
Family history (first degree relative 2x risk)
HPC1, BRCA1 and BRCA2 genes
30
Q

How does prostate cancer usually present?

A

Most newly diagnosed prostate cancers are localised and asymptomatic
Diagnosed through opportunistic PSA testing

31
Q

What is the diagnostic triad for prostate cancer?

A

PSA
Abnormal digital rectal examination
TRUS-guided prostate biopsies

32
Q

What are the symptoms of local prostate cancer?

A 
Weak stream
Hesitancy
Sensation of incomplete emptying
Frequency
Urgency
Urge incontinence
UTI
33
Q

What are the symptoms of locally invasive prostate cancer?

A 
Haematuria
Perineal and suprapubic pain
Impotence
Incontinence
Loin pain or anuria
Symptoms of renal failure
Haemospermia
Rectal symptoms
34
Q

What are the symptoms of metastases in 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
Lethargy
Weight loss
Cachexia
35
Q

What are the potential causes of an increased PSA/

A 
UTI
Chronic prostatitis
Instrumentation (eg catheterisation)
Physiological (eg ejaculation)
Recent urological procedure
BPH
Prostate cancer
36
Q

How is prostate cancer graded?

A

Gleason sum score-
number of highest area added to number of second highest area are added together for a score
Changing to ISUP grade groups

37
Q

What are the stages of prostate cancer?

A

Localised stage
Locally advanced stage
Metastatic stage
Hormone refractory stage

38
Q

What investigations can be used to stage prostate cancer?

A 
Digital rectal examination
PSA
Transrectal US guided biopsies
CT
MRI
39
Q

How is localised prostate cancer staged?

A 
T2a- <50% of one lobe
T2b- >50% of one lobe
T2c- affects both lobes
T3- invades spermatic cord
T4- invades surrounding structures
40
Q

How is localised prostate cancer managed?

A

Watchful waiting
Radiotherapy- external beam or brachytherapy
Radical prostatectomy- robotic

41
Q

How is locally advanced prostate cancer managed?

A

Watchful waiting

Hormone therapy than can be followed by surgery or radiation

42
Q

What are the possible types of hormonal therapy for prostate cancer?

A

Surgical castration
Chemical castration- LHRH analogues
Anti-androgens
Oestrogens

43
Q

How is metastatic and hormone refractory prostate cancer managed?

A

Immediate hormonal therapy

Supportive treatment can be palliative radiotherapy, colostomy, nephrostomy, zoledronic acid or palliative care support

44
Q

How does testicular cancer present?

A 
Most commonly- painless lump
Less common:
-Tender inflamed swelling
-History of trauma causing excess pain
-Symptoms/signs from nodal or distant metastases
45
Q

What are the risk factors for testicular cancer?

A

Peak incidence in third decade
Higher risk in caucasians
Risk higher in infertility, atrophic testis and previous cancer in testis

46
Q

What are the different tumour markers that can be present in testicular cancer?

A

AFP (alpfa-fetoprotein)- teratoma
BetaHCG (human chorionic gonadotrophin)- seminoma
LDH (lactate dehydrogenase)- non-specific marker of tumour

47
Q

How is a lump in the testis managed?

A 
Testicular tumour until proven otherwise
Can also be:
-Infection
-Epididymal cyst
-Missed testicular torsion
48
Q

How should a testicular lump be investigated?

A

MSSU
Testicular ultrasound scan and chest X-ray
Tumour markers

49
Q

How is testicular cancer managed?

A

Radical orchidectomy essential
May need biopsy of contralateral testis if high risk for tumour
Further treatment depends on tumour type, stage and grade

50
Q

Which group of lymph nodes does the main lymphatic spread of testicular cancer spread to?

A

Para-aortic lymph nodes

51
Q

Describe the pathology of testicular cancer

A

95% germ cell tumour
Seminoma mainly affects 30-40 year olds
Non-seminomas mainly affect 20-30 year olds

52
Q

How is testicular cancer staged?

A

Stage I- disease is confined to the testis
Stage II- Infradiaphragmatic nodes involved
Stage III- supradiaphragmatic nodes involved
Stage IV- extralymphatic disease

53
Q

How is testicular cancer treated post-orchidectomy?

A 
Low stage, negative markers:
-Surveillance
-Adjuvant radiotherapy
-Prophylactic chemotherapy
Nodal disease, persistent tumour markers or relapse on surveillance:
-Combination chemotherapy
-Lymph node dissection
Metastases:
-First-line chemotherapy
-Second-line chemotherapy

Urinary System (21 decks)

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