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Nephro > Tumours Of The Urinary Tract > Flashcards

Tumours Of The Urinary Tract Flashcards

1
Q

What are the risk factors for prostate cancer?

A 
Age 
- risk increases with age 
Hormones
Racial factors
- black
Familial and genetic factors 
- abnormalities on chromosomes 1 and 8
- BRCA2 gene mutations 
- PTEN and TP53 - tumour suppressor genes
Geographic variations
- highest in western cultures
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2
Q

What are the signs and symptoms of prostate cancer?

A 
Asymptomatic 
Painful/slow micturition 
UTI
Haematuria
Urinary retention 
Lymphoedema 
Metastatic 
- bone pain
- renal failure (ureteric obstruction)
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3
Q

What investigations are used in the diagnosis of prostate cancer?

A

Digital rectal examination
PSA - prostate specific antigen
TRUS - needle guided biopsy

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4
Q

Where in the prostate do prostate cancers normally arise?

A

Peripheral zones

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5
Q

What is the Gleason grading system?

A

Based on the extent to which the tumour cells are arranged into recognisable glandular structures and describes and spectrum of histological malignancies
<4 - well differentiated
5-7 - moderately differentiated
>7 - poorly differentiated

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6
Q

Describe the T staging (in TNM staging) of the prostate.

A

T1 - tumour can’t be seen with imaging or felt on DRE (incidental finding by transrectal US)
T2 - can be felt by DRE or seen on TRUS, but confined to the prostate
T3 - cancer has grown outside the prostate, possibly into the seminal vesicles

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7
Q

Describe the N staging (in TNM staging) of the prostate.

A

N0 - not spread to any nearby lymph nodes

N1 - cancer has spread to one or more nearby lymph ndoes

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8
Q

Describe the M staging (in TNM staging) of the prostate.

A

M0 - cancer hasn’t spread beyond nearby lymph nodes

M1 - cancer has spread beyond nearby lymph nodes

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9
Q

How does the prostate specific antigen help assess the prostate?

A

Serine protease is secreted into seminal fluid
- responsible for the liquefaction of seminal coagulation Small proportional leaks into circulation
Tissue, not tumour specific

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10
Q

What is the normal level of PSA?

A

50-59 >3ng/ml
60-69 >4ng/ml
70-79 >5 ng/ml

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11
Q

What is the treatment for localised prostate cancer?

A 
Waiting 
Radiotherapy
- external beam
- conformal 
- brachytherapy 
Radical prostatectomy 
Cryotherapy 
TURP if symptomatic
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12
Q

What are the metastatic complications of prostate cancer, and how are they treated?

A 
Spinal cord compression 
- severe pain
- retention
- urgent MRI
- radiotherapy vs spinal decompression surgery
Ureteric obstruction
- anorexia, weight loss, raised creatinine
- nephrostomise or stenting
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13
Q

What are the treatment options for advanced prostate cancer?

A 
Androgen ablation therapy  
- medical castration (LHRH analogue)
Surgical castration
TURP for symptom relief 
Chemotherapy
Radiotherapy
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14
Q

What are the risk factors for bladder cancer?

A 
Age 
- common in 80s
Race
- white
Environmental carcinogens 
Chronic inflammation
- stones, infection, long term catheters 
Drugs
- phenacitin
- cyclophsophamide 
Pelvic radiotherapy 
Smoking
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15
Q

How does bladder cancer present?

A 
Painless frank haematuria 
Microscopic haematuria (5% of cases)
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16
Q

How is bladder cancer diagnosed?

A

Cystoscopy

Renal USS/KUB

17
Q

Which types of bladder cancer are the most common?

A 
Transitional cell carcinoma (90%)
- superficial 75%
- invasive - 25%
Squamous carcinoma (5%)
Adenocarcinoma (2%)
Metastatic
18
Q

What is the grading system for bladder cancer?

A

Grade 1 - well differentiated
Grade 2 - moderately differentiated
Grade 3 - poorly differentiated
Carcinoma in situ

19
Q

Describe the tumour staging for bladder cancer.

A

Tis - carcinoma in situ
Ta - noninvasive papillary carcinoma
T1 - invasion of the lamina propria
T2 - invasion of the muscle layer of the bladder wall
T3 - tumour has spread into the perivesical tissue (fatty tissue surrounding the bladder)
T4 - tumours has spread to the (a) abdominal wall, pelvic wall or (b) prostate/seminal vesicles or uterus/vagina

20
Q

What is the treatment for bladder cancer?

A

Urgent trans-urethral resection of bladder tumour
CT IVU
Bimanual examination carrier out
Intravesicle mitomycin reduces risk of recurrence

21
Q

How is a low grade superficial (non-invasive papillary tumour) treated?

A

Low risk of progression
- flexible check cystoscopy every 3 months
6 weekly course of mitomycin treatments for persistent tumours

22
Q

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

A

50% chance of progression to muscle invasive disease
Cystoscopy and re-biopsy
Treat with intravesical BCG immunotherapy
- 6 weeks
- then further cystosopy and biopsy
Cystectomy if treatment fails

23
Q

How is muscle invasive bladder cancer treated?

A

Requires radical therapy
- cystectomy or radiotherapy
Radiotheapy doesn’t work well if there is multifocal disease or widespread CIS
Neo-adjuvant chemotherapy

24
Q

How is metastatic bladder cancer treated?

A 
Often pulmonary
Treated with chemotherapy 
- M-VAC
- methotrexate, vinblastine, doxorubicin and cisplatin 
- highly toxic
Gemicitobine and docetaxel
25
Q

What are the different types of renal tumour?

A

Renal cell carcinoma (85%)
Transitional cell carcinoma
Sarcoma
Metastases

26
Q

What are the risk factors for renal cell carcinoma?

A 
Smoking 
Obesity 
Hypertension
Acquired renal cystic disease
Haemodialysis 
Genetics
- VHL, HPRCC, tuberous sclerosis
27
Q

How do renal carcinomas present?

A 
80% incidental 
25% systemic symptoms
- night sweats
- fever
- fatigue 
- weight loss
- haemoptysis
10% classic triad
- mass, pain and haematuria 
Varicocele
Lower limb oedema
Paraneoplastic syndrome
28
Q

Name the paraneoplastic syndomes.

A 
Polycythaemia (from increased EPO)
Hypercalcaemia (PTH like substance)
Hypertension (renin secretion)
Deranged LFTs 
ACTH, prolactin, insulin and gonadotrophins ( all rare)
29
Q

How is the initial diagnosis of renal cell carcinoma made?

A 
US
FBC, UEs, LFTs, CRP, bone profile and LDH
CT kidneys 
MRI
Renal biopsy
CT chest - mets
30
Q

Describe the tumours staging of renal cell carcinomas.

A

T1 - <7cm
T2 - >7cm
T3 - enters the renal vein/IVC
T4 - extends beyond the Gerota fascia

31
Q

How is a large renal mass treated?

A

Radical nephrectomy

- removal of kidney and Gerota’s fascia (sparing the adrenal gland)

32
Q

How are small renal masses treated?

A 
Biopsy
Nephron sparing surgery (partial neprectomy or cryotherapy)
- when it affects a single kidney
- CKD
- CV risk factors 
- T1a tumours
Radical nephrectomy 
Surveillance
33
Q

How are metastatic renal cell carincomas treated?

A

Tyrosine Kinase Inhibitor

34
Q

What are the risk factors for testicular cancer?

A

Age 20-45
Cryptorchidism
HIV
Caucasian

35
Q

How does testicular cancer present?

A

Painless lump

Often found after incidental trauma

36
Q

What are the investigations for testicular cancer?

A 
Scrotal US
Tumour markers
- alpha feroprotein
- beta hCG
- LDH
37
Q

What are the different classifications of testicular cancers?

A 
Germ cell
- seminoma 
- teratoma 
- mixed
- yolk sac
Stromal tumours
- leydig
- sertoli 
Other 
- lymphoma
- metastasis
38
Q

What is the treatment for testicular cancer?

A

Radical orchidectomy
Chemotherapy
Para-aortic nodal radiotherapy
Retroperitoneal lymph node dissection

39
Q

What is the treatment for penile cancer?

A 
Circumcision 
Topical treatment CO2/5FU
Penectomy and reconstruction 
Lymphadenectomy 
Chemo/radiotherapy

Nephro (10 decks)

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