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Urology > Tumours of Urinary System > Flashcards

Tumours of Urinary System Flashcards

1
Q

What are urothelial tumours?

A

Malignant tumours of transitional cell epithelium

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2
Q

Where can urothelial tumours occur?

A

Anywhere along the renal tract

From renal calyces to tip of urethra

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3
Q

Where is the most common site (90%) of urothelial tumours?

A

Bladder

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4
Q

What is the commonest tumour of the bladder?

A

Transitional cell carcinoma

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5
Q

What endemically can cause squamous cell carcinoma of the bladder?

A

Schistosomiasis

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6
Q

What are the risk factors for TCC?

A

Smoking
Aromatic amines
non-hereditary genetic abrnormalities

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7
Q

What are the risk factors for squamous cell carcinoma of bladder?

A

Schistosomiasis
Chronic cystitis
Cyclophosphamide
Pelvic radiotherapy

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8
Q

Where are the vast majority of adenocarcinomas of the bladder found?

A

Urachal

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9
Q

What are the common presenting features of bladder cancer?

A 
Painless visible haematuria 
Symptoms due to metastatic disease 
Recurrent UTI 
Storage bladder symptoms 
e.g:
- dysuria 
-frequency
-nocturia
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10
Q

What is the commonest cause of painful haematuria?

A

UTI

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11
Q

What investigations should be done for suspected bladder cancer?

A 
Urine culture 
Cystourethroscopy 
CT urogram 
USS 
Urine cytology 
BP 
U&E
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12
Q

What is the risk of malignancy in frank haematuria?

A

High

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13
Q

What is the next line investigation for frank haematuria>

A

Flexible cystoscopy within 2 weeks

IVU & USS

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14
Q

What is the malignancy risk of dipstick microscopic haematuria?

A

Lower

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15
Q

What is the next line investigation for microscopic haematuria?

A

Flexible cystoscopy within 4-6 weeks

IVU & USS

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16
Q

How is diagnosis for bladder cancer made>

A

Cystocopy and endoscopic resection

EUA to asses bladder mass/thickening

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17
Q

What staging is used for bladder cancer?

A

TNM

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18
Q

How is bladder cancer staged?

A

CT

MRI

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19
Q

What is the treatment for bladder cancer?

A

TURBT

Radical

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20
Q

What is Grade 1 of bladder cancer?

A

Well differentiated

Commonly non-invasive

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21
Q

What are features of grade 2 bladder cancer?

A

Moderately differentiated

Often non-invasive

22
Q

What are features of grade 3 bladder cancer?

A

Poorly differentiated

Often invasive

23
Q

What are the 2 descriptions of T stages in bladder cancer?

A

Non-muscle invasive

Muscle invasive

24
Q

Which muscle is invaded in bladder cancer?

A

Detrusor m.

25
Q

`What is the treatment for low grade non-muscle invasive bladder cancer?

A

TURBT
Followed by single instillation intravesical chemo within 24 hrs
Prolonged endoscopic follow up for moderate grade tumours - cystoscopy on regular basis

26
Q

What is the treatment for high grade non-muscle invasive bladder tumour?

A

Very aggressive

Endoscopic resection alone not sufficient

27
Q

What should CIS bladder tumour treatment be>

A

Intravesical BCG therapy

Weekly for 3 weeks repeated 6 monthly over 3 years

28
Q

What is the treatment for muscle invasive bladder cancer?

A

Neoadjuvant chemo for local and systemic control
Radical radiotherapy and/or
radical Cystoprostatectomy (men) or anterior pelvic exenteration with urethrectomy (women); with extended lymphadenectomy

29
Q

What is the prognosis of bladder cancer dependent on?

A

Stage
Grade
Size
Multifocality

30
Q

What are the main symptoms of Upper tract urothelial cancer?

A

Frank haematuria
Unilateral ureteric obstruction
Flank or loin pain

31
Q

What are some symptoms of metastatic UTUC cancer?

A

Bone pain

Hypercalcaemia

32
Q

What investigations should be done for UTUC?

A

CT IVU
Urine cytology
Uteroscopy and biopsy

33
Q

Where is upper tract TCC more commonly found?

A

Renal pelvis

or collecting system

34
Q

Where is upper tract TCC less commonly found?

A

Ureters

35
Q

What is there a high risk of in endoscopic resection in upper tract TCC?

A

Local recurrence

36
Q

How are most upper tract TCC best treated?

A

By radical nephro-ureterectomy

RNU

37
Q

What is nephro-ureterectomy?

A

Minimally invasive surgical procedure to remove the renal pelvis, kidney and entire ureter, along with the bladder cuff

38
Q

Name 2 benign renal tumours?

A

Oncocytoma

Angiomyolipoma

39
Q

What is the commonest malignant renal tumour?

A

Renal adenocarcinoma

40
Q

Where do most renal adenocarcinomas arise from?

A

Proximal tubules

41
Q

What is the commonest histological subtypes of renal adenocarcinoma?

A

Clear cell

42
Q

What are the risk factors for Renal adenocarcinoma?

A 
FH 
Smoking 
Anti-hypertensives 
Obesity 
End-stage renal disease
43
Q

What is the typical presentation of renal carcinoma?

A

Asymptomatic with incidental finding (50%)

Classic triad

  1. flank pain
  2. mass
  3. haematuria

Paraneoplastic syndrome

Metastatic disease
e.g bone pain

44
Q

Where are common sites of metastases for renal cancer?

A

Bone
Brain
Lung
Liver

45
Q

How is renal cancer staged?

A

CT

46
Q

What staging is used for renal cancer?

A

TNM

47
Q

What is TNM T1 for renal carcinoma?

A

<7cm

Confined within renal capsule

48
Q

What is TNM T2 for renal cancer?

A

Local extension outside capsule

49
Q

What is T3 TNM for renal cancer?

A

Local extension outside capsule

T3b and T3c involved vena cava

50
Q

Where can renal cancer have venous invasion to?

A

IVC

51
Q

What investigations are done for renal cancer?

A

CT

Blood; U&E, FBC

52
Q

What is the treatment for renal cancer?

A

Radical nephrectomy
- laparoscopic or open
Palliative cytoreductive nephrectomy in metastatic disease
Immunotherapy

Urology (13 decks)

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