Upper Tract Uothelial Carcinoma (UTUC) Flashcards
Risk factors for UTUCs:
Smoking
Aromatic amines
Phenacetin
Balkan endemic nephropaty
Endemic in sothwest Taiwan: aristolochoic acid
Polymorphisms: SULT1A1 reduction of sulfotransferase activity
Hereditary linked to HNPCC (lynch syndrome)
What types of cancers can individuals with HNPCC (lynch syndrome) get?
Endometrial Stomach UTUCs Biliary ducts Ovarian Small intestines Skin Brain
When should Lynch syndrome be suspected?
UTUC in patient <60 years and
personal history of HNPCC-type cancer
or
First degree relalitve <50 years old with HNPCC-type cancer
or
Two first degree relatives with HNPCC-type cancer
What is the recommended investigation for suspected UTUC?
Urinary cytology
Cystoskopy to rule out concomittant bladder tumour
CT urography
The sensivity for cytology in UTUCs is less or greater than bladder cancer?
less sensitive
With how much does NBI (narrow band imaging) increase detection rate of UTUCs?
23%
What can you use Optical Coherence Tomography for?
Staging of UTUCs
What share of biopsies from the urether are non diagnostic for UTUC?
20%
Pre-operative prognostic factors for UTUCs (12):
Tumour focality Tumour location Grade (biopsy, cytology) Age BMI Tobacco comsumption ECOG ASA score systemic symptoms hydronephrosis Delayed surgery >3 months Neutrophil-to-lymphocyte ratio
Intra- and post-operative prognostic factors for UTUCs (10):
Stage Grade CIS Lymphovascular invasion Lympnode involvement Tumour architecture Positive surgical margins Tumour necrosis Variant histology Distal urether management
What share of patients with a diagnos of a G1 tumour from URS biopsies where upgraded?
96%
What are the criterias for Low-risk UTUCs?
Unifocal disease Tumour size < 2cm Low-grade cytology Low-grade URS biopsy Non invasive on CT-urography
OBS all criteria must be present
What are the criterias for High-risk UTUCs?
Multifocal disease Tumour size > 2cm High-grade cytology High-grade URS biopsy Hydronephrosis Previous radical cystectomy for bladder cancer
Which are the factors that are best in predicting ≥ pT2 disease in UTUCs?
High grade cytology or biopsy
Tumour size > 2 cm
After endoscopic treatment of a UTUC, when should you perform a second look?
within 2 months
When using laser vaporisation of a UTUC, what is the correct surgical technique?
Laser settings: 10Hz/1J
Don’t touch the tumour
Apnoe
What are the criterias for Segmental Distal Ureterectomy?
Solitary tumour
Lower 1/3 of the ureter
Stage ≤ p T2
Is there a difference between renal pelvis & ureteral tumours with regards to bladder recurrence, overall recurrence, cancer-specific or overall survival?
No
Which is the superior technique for radical nefroureterectomy, open or laprascopic?
They are comparable when it comes to recurrence and disease-specific survival
What technique is not recommended for the management of the bladder cuff in a radical nephroureterectomy?
Extravesical approach
Intravesical approach
(or a combination of extravescal and intravesical)
Endoscopic approach
What technique is recommended for the management of the bladder cuff in a radical nephroureterectomy?
Transvesical approach
What are the benefits of performing a Lymph node dissection at the time of a radical nephroureterectomy?
Staging
Therapeutic benefit
When is Lymph node disseiction recommended in UTUCs?
Muscle-invasive UTUCs
In patients with high-risk upper tract urothelial carcinoma which of the following statements is true?
- Adjuvant chemotherapy after radical nephroureterectomy iproves progression-free survival
- Singe dose intravesical chemotherapy after radical nephroureterectomy lower intravesical recurrence rate
- The open approach is preferred to the laparascopic in clinicallay non organ confined disease
- Lymphadenectomy should be performed in all invasive cases
- All of the above
- All of the above
