Tumours of the urinary tract wip

Question 1

What are the risk factors for prostate cancer?

Answer 1

• Age
• Familial and genetic factors - BRCA2, PTEN, TP53
• Hormones
• African American
• Higher incidence in westernised nations

Question 2

what are the symptoms of prostate cancer?

Answer 2

• Often asymptomatic
• Painful or slow micturition
• UTI
• Haematuria
• Urinary retention (may cause anuria, uraemia)
• Lymphoedema

Question 3

What are the investigations for prostate cancer?

Answer 3

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

Question 4

What is the most common cancer type in prostate cancer?

Answer 4

Adenocarcinoma

Question 5

Where does prostate cancer most commonly arise?

Answer 5

In the peripheral zone of the prostate

Question 6

What is the pathological scoring system used for prostate cancer?

Answer 6

Gleason grading

Question 7

Explain the Gleason grading system

Answer 7

• 6- histologically well differentiated
• 7- moderately differentiated
• > 7 poorly differentiated

Question 8

Explain the presence of PSA in the blood

Answer 8

• Serine protease is secreted into the seminal fluid
• Responsible for the liquefaction of seminal coagulation. It efficiently hydrolyses semenogelins causing the release of sperm
• A small proportion leaks into the circulation

Question 9

What are the treatment options for a localised prostate cancer?

Answer 9

•Watchful waiting 
•Active surveillance 
•radiotherapy 
 - external beam 
 - conformal 
 - brachytherapy 
•Radical prostatectomy 
•Cryotherapy 
•TURP if symptomatic (take out core of prostate)

Question 10

What are the metastatic complications of prostate cancer?

Answer 10

•Spinal cord compression

• urological emergency
• severe pain
• off legs
• retention
• constipation
• needs an urgent MRI
• radiotherapy or spinal decompression surgery

•Ureteric obstruction

• anorexia, weight loss, raised creatinine
• option to nephrostomize or stent (will not improve cancer progression

Question 11

What are the treatment options for advanced prostate cancer?

Answer 11

• Androgen ablation therapy - medical castration or surgical castration
• Chemotherpay
• TURP for relief of symptoms
• radiotherapy

Question 12

Explain the hypothalamic-pituitary-testicular axis

Answer 12

• Hypothalamus secretes LHRH and CRH (corticotrophin releasing hormone)
• Pituitary secretes ACTH which acts on the adrenals and LH and FSH which act on the testes causing them to secrete testosterone leading to increased adenocarcinoma of the prostate

Question 13

What are the risk factors for bladder cancer?

Answer 13

• Age - rare in under 50s
• Race - more common in caucasians
• Environmental carcinogens
• Chronic inflammation - stones, infection (schistosomiasis), long term catheters
• Drugs - phenacetin, cyclophosphamide
• Pelvic radiotherapy
• Occupation (rubber, dye, retro-chemical, plumbers)

Question 14

What is the presentation of bladder cancer?

Answer 14

• Classically painless frank haematuria

* Some present with microscopic haematuria

Question 15

What should you do if a patient presents with painless frank haematuria?

Answer 15

Cystoscopy, renal USS/KUB

Question 16

What are the most common bladder cancers?

Answer 16

• Transitional cell carcinoma (superficial and invasive)
• Squamous carcinoma
• Adenocarcinoma

Question 17

When is bladder cancer diagnosed

Answer 17

At flexible cystoscopy

Question 18

What happens once bladder cancer is diagnosed?

Answer 18

• Urgent TURBT booked (bimanual examination carried out at TURBT)
• CT IVU

Question 19

What reduces the risk of recurrence of bladder cancer?

Answer 19

Intravesical mitomycin