Tumours of Urinary System Flashcards
What is the most common cause of bladder cancer?
TCC
Where is SCC of the bladder commone?
Where schistosomiasis is endemic
What are the causes of TCC?
Smoking, aromatic amines, non-hereditary genetic abnormalities
What are the causes of SCC?
Schistomiasis, chronic cystitis, pelvic radiotherapy
What are the presenting features of bladder cancer?
Painless, visible haematuria, recurrent UTI, Dysuria, frequency, nocturia, urgency, bladder pain
What tests should be done to investigate HAEMATURIA?
Urine culture, CT, ultrasound, cystourethroscopy, BP, u&es, dipstick
What are the grades of TCC?
G1 - well differentiated (commonly non-invasive)
G2 - moderately differentiated (often on-invasive)
G3 - poorly differentiated (often invasive)
Carcinoma In Situ - non muscle invasive but V aggressive
Ta or T1 grading
Low grade, non-muscle invasive
- resection and chemotherapy
- endoscopic follow up
High grade non-muscle invasive or CIS?
V aggressive
Endoscopic resection alone isnt sufficieny
-BCG Therapy
T2/T3 grading bladder cancer
Muscle invasive bladder cancer
-neoadjuvant therapy, radical radiotherapy, cystoprostectomy, urethrectomy
What is the prognosis for bladder cancer?
non invasive and low grade - 90% survival rate after 5 years
high grade and invasive - 50% survival after 5 years
What are the main presentations of an Upper Tract Urothelial Cancer ?
Frank haematuria, unilateral ureteric obstruction, flank or loin pain, symptoms of metastatic disease
How is UTUC diagnosed?q
CT-IVU, urine cytology or ureteroscopy and biopsy
What does an IVU/CT-IVU show in UTUC?
defect in filling renal pelvis
What are features of UT TCC?
Renal pelvis/collecting system > ureter
Tumours high grade and recurrence risk is high
Treated via nephro-ureterectomy
Name some benign renal tumours?
Oncocytoma, angiomyolipoma
Name a malignant renal tumour?
Renal adenocarcinima
What are risk factors for Renal Adenocarcinoma?
FH, smoking, anti-hypertensive medication, obesity, end-stage renal failure
What are the stages of renal cancer?
T1 - Tumour <7cm with intact renal capsule
T2 - Tumour >7cm with intact renal capsule
T3 - local extension outside capsule
T3a - into adrenal or
peri-renal fat
T3b - into real
vein/IVC below
diaphragm
T3c - Tumour
thrombus in IVC
extends above
diaphragm
T4 - tumour invades beyond Gerota's fasciaWhere does renal adenocarcinoma spread?
Direct spread through renal capsule > venous invasion to renal vein and IVC > spread to lungs and bone or to paracaval nodes
What investigations should be done in renal adenocarcinoma?
CT or abdo and chest
FBC, U&E
Ultrasound
What treatment is given for renal adenocarcinoma?
Radical nephrectomy
How does locally invasive prostate cancer present?
Haematuria, perineal and suprapubic pain, impotence, incontinence, loin pain/anuria, haemospermia or tenesmus
How does distant metastasis present in prostate cancer?
Bone pain or sciatica, paraplegia due to spinal cord compression, lymphnode enlargement, loin pair or anuria, lethargy, weight loss, cachexia
What test should be done to confirm prostate cancer?
PSA, CT, FBC, MRI, Rectal Examination
What can cause elevations in PSA levels?
UTI, Chronic Prostatitis, Catheterisation, Ejaculation, BPH, Prostate cancer
What are the stages of prostate cancer?
Localised
Locally Advanced
Metastatic
Hormone Refractory
What is the treatment for localised prostate cancer?
Radiotherapy, prostatectomy
What is the treatment for locally advanced prostate cancer?
Hormone therapy followed by surgery/radiation
What forms of hormonal therapy are delivered in prostate cancer?
Surgical castration, chemical castration, anti-androgens, oestrogens
What is the most common type of testicular cancer?
GCT -95%
What age groups do seminomas affect?
30-40 Year Olds
What age groups do no-semiomatous cancers affect?
20-30 year olds
What is stage 1 testicular cancer?
Disease confined to testis
What is stage 2 testicular cancer?
infradiaphragmatic nodes involved
What is stage 3 testicular cancer?
supradiagphragmatic nodes involved
What is stage 4 testicular cancer?
Extralymphatic disease
What is the treatment for testicular cancer?
Orchidectomy, chemotherapy, radiotherapy, lymph node dissection
