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Nephrology and Urology > Tumours of the Urinary Tract > Flashcards

Tumours of the Urinary Tract Flashcards

1
Q

What is the most common urological malignancy?

A

Prostate cancer

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2
Q

What are the risk factors for prostate cancer?

A 
Increasing age
Genetic factors (BRCA2, PTEN, TP53 mutations)
Family history
Hormone
African American
Western countries
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3
Q

Prostatic cancer is often asymptomatic. T/F?

A

True

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4
Q

What are the symptoms of prostate cancer?

A 
Painful/slow micturition
Urinary retention
UTI
Haematuria
Lymphoedema
Bone pain/ renal failure due to metastases
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5
Q

How is prostate cancer diagnosed?

A

Rectal examination
PSA
Prostate MRI
Guided needle biopsy

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6
Q

What type of cancer is prostate cancer?

A

Adenocarcinoma

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7
Q

In which region of the prostate does prostate cancer usually arise?

A

Peripheral zone

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8
Q

What grading system is used for looking at prostate cancer?

A

Gleason gradin system

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9
Q

Describe the Gleason grading system of prostate cancer

A

Based on the extent to which tumour cells are arranged into recognisably glandular structures
Sum of the two most prominent Gleason grades seen histologically in a sample

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10
Q

What is prostate specific antigen?

A

A serine protease which is secreted into the spinal fluid and is responsible for liquefaction of seminal coagulation

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11
Q

What factors, other than prostate cancer, can cause an elevated PSA?

A

Increased age
Increased prostate size
Influenced by inflammation and infection

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12
Q

PSA can be used to monitor the progression of prostate cancer. T/F?

A

True

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13
Q

What are the treatments for asymptomatic localised prostate cancer?

A

Watchful waiting
Active surveillance
Radiotherapy +/- LNRH analogue
Brachytherapy

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14
Q

What are the treatments for symptomatic localised prostate cancer?

A

Radical prostectomy
Chemotherapy
TURP

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15
Q

Describe why both GnRH agonists and antagonists can be used to treat prostate cancer.

A

Prostate cancer is driven by testosterone. Tesoterone production can be inhibited by inhibiting GnRH by antagonists however these are poorly tolerated. GnRH agonists cause an initial flare of testosterone (which should be blocked peripherally) that then, by feedback effect, decreases testosterone production over a period of weeks

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16
Q

What are the key metastatic complications of prostate cancer?

A

Spinal cord compression

Ureteric obstruction

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17
Q

What are the signs and symptoms of spinal cord compression due to prostate cancer metastases?

A

Severe pain
Urinary retention
Constipation

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18
Q

How should spinal cord compression as a result of prostate cancer metastases be treated?

A

Radiotherapy

Spinal decompression surgery

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19
Q

How should spinal cord compression as a result of prostate cancer metastases be investigated

A

MRI

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20
Q

What are the signs and symptoms of ureteric obstruction due to prostate cancer metastases?

A

Anorexia
Weight loss
Raised creatinine

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21
Q

How should ureteric obstruction as a result of prostate cancer metastases be treated?

A

Nephrostomy

Stents

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22
Q

What are the options for androgen ablation therapy in prostate cancer?

A

Medical castration with LnRH analogues or surgical castration via orchidectomy

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23
Q

How is advanced prostate cancer treated?

A

Androgen ablation therapy
Chemotherapy
TURP
Radiotherapy

24
Q

What are the risk factors for bladder cancer?

A 
Male
Increasing age
Caucasian
Chronic inflammation
Drugs - cyclophosphamide, pioglitazone
Pelvic radiotherapy
Smoking
Occupation
25
Q

What is the typical presentation of bladder cancer?

A

Painless frank haematuria

26
Q

How should patients with suspected bladder cancer be investigated?

A

Cystoscopy and upper tract imaging

27
Q

What type of cancer is the majority of bladder cancer?

A

Transitional cell carcinoma

28
Q

In addition to transitional cell carcinoma, what types of cancer can occur in bladder cancer?

A

Squamous carcinoma

Adenocarcinoma

29
Q

It is important to determine whether or not bladder cancer is muscle invasive. T/F?

A

True

30
Q

There should always be urgent trans-urethral resection of a bladder tumour. T/F/

A

True

31
Q

What imaging is used to monitor for associated upper tract cancers in bladder cancer?

A

CT intravenous urogram.

32
Q

What drug is used in chemotherapy for bladder cancer?

A

Mitomycin C

33
Q

What chemotherapy regimens are used for bladder cancer?

A

Mitomycin C once off after surgery or a 6 week course

34
Q

What is used as the basis of immunotherapy in bladder cancer?

A

BCG

35
Q

What is involved in radical cystectomy?

A

Removal of the bladder and prostate/uterus, urine is diverted

36
Q

What type of cancer is most renal cancer?

A

Renal cell carcinoma

37
Q

Other than renal cell carcinoma, what types of renal cancer exist?

A

Transitional cell Caricnoma
Sarcoma
Metastases

38
Q

There does not need to be metastases for systemic symptoms to be present in renal cancer. T/F?

A

True

39
Q

What is the peak age of incidence of renal cancer?

A

40-70 years

40
Q

What are the risk factors for renal cancer?

A 
Male
Age 40-70 years
Smoking
Obesity
Hypertension
Acquired renal cystic disease
Haemodialysis
Genetics (VHL, HPRCC, HLRCC, Birthings-Hogg Dube, tuberous sclerosis)
41
Q

Most renal cancer is an incidental diagnosis. T/F?

A

True

42
Q

What are the signs/symptoms of renal cancer?

A 
Mass
Pain
Haematuria
Weight loss
Fever
Night sweats
Fatigue
Varicocele
Lower limb oedema
Paraneoplastic syndrome
43
Q

What are the possible paraneoplastic syndromes of renal cancer?

A 
Polycythaemia
Hypercalcaemia
Hypertension
Deranged LFTs
Cushing's
Protein enteropathy
Galactorrhea
Hypoglycaemia
44
Q

How is renal cancer diagnosed?

A

Ultrasound
CT
Renal biopsy

45
Q

Collecting duct and medullar cell. renal cancer is rare. T/F?

A

True

46
Q

What is the treatment for renal cancer?

A

Surgical treatment. - tailored to patient and dependent on tumour stage
Tyrosine kinase inhibitors in metastatic disease

47
Q

What is the peak age of incidence of testicular cancer?

A

25-45 years

48
Q

What are the risk factors for testicular cancer?

A

Age 25-45 years
Cryptorchidism
HIV
Caucasian

49
Q

How is possible testicular cancer investigated?

A

Scrotal ultrasound
Tumour markers
CT staging

50
Q

What are the tumour markers of testicular cancer?

A

Alpha fetoprotein
Beta hCG
LDH

51
Q

What is the most common type fo testicular cancer?

A

Germ cell tumours

52
Q

What are the different types of testicular cancer?

A 
Germ cell tumours
Seminomas
Teratomas
Mixed or yolk sac tumours
Sertoli tumours
Leydig tumours
Lymphoma
Metastases
53
Q

How is testicular cancer treated?

A

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

54
Q

What is penile cancer associated with?

A

HPV infection

Smoking

55
Q

Circumcision at birth decreases the risk of penile cancer. T/F?

A

True

56
Q

How is penile cancer treated?

A 
Circumcision
Topical treatment (CO2, 5FU)
Penectomy +/- reconstruction
Lymphadenopathy
Chemo-Radiotherapy

Nephrology and Urology (13 decks)

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