Tumours of the Urinary Tract

Question 1

What is the most common urological malignancy?

Answer 1

Prostate cancer

Question 2

What are the risk factors for prostate cancer?

Answer 2

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

Question 3

Prostatic cancer is often asymptomatic. T/F?

Answer 3

True

Question 4

What are the symptoms of prostate cancer?

Answer 4

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

Question 5

How is prostate cancer diagnosed?

Answer 5

Rectal examination
PSA
Prostate MRI
Guided needle biopsy

Question 6

What type of cancer is prostate cancer?

Answer 6

Adenocarcinoma

Question 7

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

Answer 7

Peripheral zone

Question 8

What grading system is used for looking at prostate cancer?

Answer 8

Gleason gradin system

Question 9

Describe the Gleason grading system of prostate cancer

Answer 9

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

Question 10

What is prostate specific antigen?

Answer 10

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

Question 11

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

Answer 11

Increased age
Increased prostate size
Influenced by inflammation and infection

Question 12

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

Answer 12

True

Question 13

What are the treatments for asymptomatic localised prostate cancer?

Answer 13

Watchful waiting
Active surveillance
Radiotherapy +/- LNRH analogue
Brachytherapy

Question 14

What are the treatments for symptomatic localised prostate cancer?

Answer 14

Radical prostectomy
Chemotherapy
TURP

Question 15

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

Answer 15

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

Question 16

What are the key metastatic complications of prostate cancer?

Answer 16

Spinal cord compression

Ureteric obstruction

Question 17

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

Answer 17

Severe pain
Urinary retention
Constipation

Question 18

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

Answer 18

Radiotherapy

Spinal decompression surgery

Question 19

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

Answer 19

MRI

Question 20

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

Answer 20

Anorexia
Weight loss
Raised creatinine

Question 21

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

Answer 21

Nephrostomy

Stents

Question 22

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

Answer 22

Medical castration with LnRH analogues or surgical castration via orchidectomy

Question 23

How is advanced prostate cancer treated?

Answer 23

Androgen ablation therapy
Chemotherapy
TURP
Radiotherapy

Question 24

What are the risk factors for bladder cancer?

Answer 24

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

Question 25

What is the typical presentation of bladder cancer?

Answer 25

Painless frank haematuria

Question 26

How should patients with suspected bladder cancer be investigated?

Answer 26

Cystoscopy and upper tract imaging

Question 27

What type of cancer is the majority of bladder cancer?

Answer 27

Transitional cell carcinoma

Question 28

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

Answer 28

Squamous carcinoma | Adenocarcinoma

Question 29

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

Answer 29

True

Question 30

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

Answer 30

True

Question 31

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

Answer 31

CT intravenous urogram.

Question 32

What drug is used in chemotherapy for bladder cancer?

Answer 32

Mitomycin C

Question 33

What chemotherapy regimens are used for bladder cancer?

Answer 33

Mitomycin C once off after surgery or a 6 week course

Question 34

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

Answer 34

BCG

Question 35

What is involved in radical cystectomy?

Answer 35

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

Question 36

What type of cancer is most renal cancer?

Answer 36

Renal cell carcinoma

Question 37

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

Answer 37

Transitional cell Caricnoma Sarcoma Metastases

Question 38

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

Answer 38

True

Question 39

What is the peak age of incidence of renal cancer?

Answer 39

40-70 years

Question 40

What are the risk factors for renal cancer?

Answer 40

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

Question 41

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

Answer 41

True

Question 42

What are the signs/symptoms of renal cancer?

Answer 42

``` Mass Pain Haematuria Weight loss Fever Night sweats Fatigue Varicocele Lower limb oedema Paraneoplastic syndrome ```

Question 43

What are the possible paraneoplastic syndromes of renal cancer?

Answer 43

``` Polycythaemia Hypercalcaemia Hypertension Deranged LFTs Cushing's Protein enteropathy Galactorrhea Hypoglycaemia ```

Question 44

How is renal cancer diagnosed?

Answer 44

Ultrasound CT Renal biopsy

Question 45

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

Answer 45

True

Question 46

What is the treatment for renal cancer?

Answer 46

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

Question 47

What is the peak age of incidence of testicular cancer?

Answer 47

25-45 years

Question 48

What are the risk factors for testicular cancer?

Answer 48

Age 25-45 years Cryptorchidism HIV Caucasian

Question 49

How is possible testicular cancer investigated?

Answer 49

Scrotal ultrasound Tumour markers CT staging

Question 50

What are the tumour markers of testicular cancer?

Answer 50

Alpha fetoprotein Beta hCG LDH

Question 51

What is the most common type fo testicular cancer?

Answer 51

Germ cell tumours

Question 52

What are the different types of testicular cancer?

Answer 52

``` Germ cell tumours Seminomas Teratomas Mixed or yolk sac tumours Sertoli tumours Leydig tumours Lymphoma Metastases ```

Question 53

How is testicular cancer treated?

Answer 53

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

Question 54

What is penile cancer associated with?

Answer 54

HPV infection | Smoking

Question 55

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

Answer 55

True

Question 56

How is penile cancer treated?

Answer 56

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