Tumours of Urinary System 1&2

Question 1

What are the risk factors for prostate cancer?

Answer 1

+ve FH - HPC1 and BRCA1 & 2

Age (80% in men > 80 years)

Question 2

How does prostate cancer present?

Answer 2

Asymptomatic

or

• Nocturia
• Hesitancy
• Poor stream
• Terminal dribbling

Question 3

How is prostate cancer detected and diagnosed?

Answer 3

1) Opportunistic PSA testing (NOT screening):
- PSA results are prostate specific, but not cancer specific
2) Digital rectal examination
3) Transrectal USS + Biopsy

Question 4

How are localised prostate cancers managed?

Answer 4

Low-risk:

Watchful waiting

Surgery

Intermediate risk:

Surgery

Radiotherapy

High risk:

Radiotherapy

Question 5

How does testicular cancer present?

Answer 5

Painless lump

Question 6

What are the markers of testicular cancer?

Answer 6

AFP (Alpha-fetoprotein)

Human Chorionic Gonadotrophin

Lactate Dehydrogenase

Question 7

How is testicular cancer diagnosed?

Answer 7

1) Lump in testis = tumour until proven otherwise
2) MSSU
3) Testicular USS
4) Tumour markers

Question 8

How is testicular cancer treated?

Answer 8

Radical orchidectomy (removal of testicles)

Question 9

Where is testicular cancer most likely to spread to in terms of lymph nodes?

Answer 9

Para-aortic

Question 10

What is the most common testicular cancer type?

Answer 10

Germ cell tumour

Question 11

What are the risk factors for bladder cancer?

Answer 11

TCC:

• Smoking
• Aromatic amines
• Genetic abnormalities

SCC:

• Schistosomiasis
• Chronic cystitis

Question 12

What are the presenting features of bladder cancer?

Answer 12

1) Painless visible haematuria - most common
2) Metastatic symptoms - occasionally
3) Haematuria
4) Recurrent UTI
5) Storage symptoms (dysuria, frequency, nocturia, urgency)

Question 13

How is haematuria investigated?

Answer 13

1) Urine culture
2) Urine cytology
2) Cystoscopy with biopsy
3) CT/MRI

Question 14

How is bladder cancer treated?

Answer 14

Ta/T1:

• Endoscopic resection with single dose of chemo
• Prolonged endoscopic follow up

T2-3:

• Cystectomy gold standard

Question 15

What are the presenting symptoms of Upper tract TCC?

Answer 15

1) Frank haematuria
2) Unilateral ureteric obstruction
3) Flank or loin pain
4) Symptoms of metastatic spread

Question 16

How is UTUC diagnosed/investigated?

Answer 16

CT-IVU or IVU (will show filling defects in renal pelvis)

Urine cytology

Ureteroscopy + biopsy

Question 17

How are UTUC’s treated?

Answer 17

Nephro-ureterectomy

Question 18

What are the risk factors for renal adenocarcinoma?

Answer 18

+ve FH

Smoking

Anti-hypertensive meds

Obesity

End-stage renal failure

Question 19

What is the presentation of renal adenocarcinoma?

Answer 19

1) Asymptomatic
2) Classic triad - flank pain, mass + haematuria
3) Hypertension, hypercalcaemia and abnormal LFT’s

Question 20

How is renal cancer staged?

Answer 20

T1 - <7cm and inside renal capsule

T2 - >7cm and outside renal capsule

T3 - extension outside capsule

a- into adrenal/peri-renal fat

b - into renal vein or IVC

c - above diapgram

T4 - Beyond gerota’s fascia

Question 21

In which nodes does renal cancer spread?

Answer 21

Para-caval nodes

Question 22

How is renal cancer investigated?

Answer 22

CT abdo + chest scan

Bloods - U&E, FBC

Question 23

How is renal cancer treated?

Answer 23

Laparoscopic nephrectomy

Question 24

What is the prognosis for renal cancer?

Answer 24

T1 - 95% 5 years

T2 - 90% 5 years

T3 - 60% 5 years

T4 - 20% 5 years