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Kofi: Pure Clinical Sem 3 > Urinary: Cancer & APCKD > Flashcards

Urinary: Cancer & APCKD Flashcards

1
Q

How does renal cell carcinoma present?

A
  • Localised or advanced
  • Haematuria
  • Incidental finding on imaging
  • Palpable mass is rare

If advanced

  • Large varicoele may be present
  • Pulmonary/tumour embolus
  • Loss of weight/loss of appetite
  • Hypercalcaemia
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2
Q

How does a transitional cell carcinoma present?

A
  • Localised
  • Haematuria
  • Incidental finding on imaging

If advanced

  • Loss of weight/loss of apetite/symptom of metastasis
  • DVT
  • Lymphoedema
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3
Q

What is the percentage of patient with visible haematuria and over 45 that present with cancer?

A

20%

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4
Q

What is the history undertaken if cancer in urinary tract is suspected?

A
  • Smoking history
  • Occupation history
  • Painful or painless – painless is more worrying from a cancer point of view. Painful is likely external
  • Other LUTS – beginning of steream. Prostate cancer
  • Family history
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5
Q

What is the examination undertaken if cancer in urinary tract is suspected?

A
  • BP
  • Abdominal mass – ulickly to be cancer
  • Varicocele
  • Leg swelling – lympadema (blockage of lymph node by cancer)
  • Asses prostate by DRE (Size, Texture)
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6
Q

What are the types of test undertaken for haematuria?

A
  • Radiology
  • Endoscopy
  • Urine
  • Blood tests
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7
Q

What are the radiological test performed in haematuria?

A
  • Ultrasound (can pick up bladder cancer but not the smallest of cancer)
  • CT (need good kidney function to be able to inject contrast)
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8
Q

What is an example of an endoscopic test?

A

-Flexible cystoscopy to look inside the bladder

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9
Q

What are the Urine tests done?

A
  • Culture and sensitivity

- Cytology

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10
Q

Describe the epidemiology of Renal Cell Carcinoma.

A
  • 7th most common cancer in Uk
  • 95% of all upper urinary tract tumours
  • Rising incidence and mortality
  • Common in men and whites
  • 30% metastases on presentation
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11
Q

What is the aetiology of RCC?

A
  • Smoking
  • Obesity
  • Dialysis
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12
Q

Where does renal cell carcinoma spread?

A
  • Spread to the right atrium via IVC (can embolise to the lung to cause a pulmonary embolism)
  • Perinephric spread
  • Lymph node metastases
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13
Q

What is the treatment for localised renal cell carcinoma?

A
  • Surveillance
  • Excison via radical nephrectomy or partial nephrectomy
  • Ablation (cyroablation, radiofrequency ablation)
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14
Q

What is the treatment for metastatic Renal Cell Carcinoma?

A

Palliative (Chemo- and radio- resistant)

  • Biological therapies – act on the cell cycle, vaccine, monoclonal antibodies.
  • Those targeting angiogenesis are now 1st choice. Tyrosine kinase inhibitors given
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15
Q

Describe epidemiology of Bladder

A
  • In UK, 8th most common cancer in men and 14th in women.
  • Incidence is decreasing
  • Presentation is often more advanced in women
  • 3X more in men
  • More in White than non-white
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16
Q

What are risk factors of Bladder TCC?

A
  • White
  • Male
  • Smoking
  • Occupational exposure
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17
Q

What are some occupational exposure for bladder TCC?

A
  • Dye more carcinogenic
  • Handling of poly aromatic hydrocarbons
  • Painters, mechanics, printers, hairdressers
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18
Q

What is the initial treatment for bladder TCC?

A

-TUR bladder tumour

19
Q

What is the staging of bladder TCC?

A 
Ta – rare chance of death
T1
T2 -– low survival as muscle invasive from here
T3
T4
20
Q

What is the histological grading of TCC?

A
  • Normal
  • Grade 1
  • Grade 2
  • Grade 3
  • Carcinoma in Situ (grade 3 tumour that has yet to invade)
21
Q

What are further treatments for high risk and low risk non muscle-invasive TCC?

A

High-Risk

  • Check cystoscopies
  • Intravesical immunotherapy

Low-risk

  • Check cystoscopies
  • Intravesical immunotherapy or not
22
Q

What is further treatment for muscle invasive TCC?

A
  • Neoadjuvant chemotherapy
  • Radical (Cystectomy or Radiotherapy)

If not curative, Palliative chemotherapy/radiotherapy

23
Q

What is the aetiology for Upper Urinary Tract TCC?

A
  • Smoking
  • Phenacetin abuse
  • Balkan’s Nephropathy
24
Q

Describe the epidemiology of Upper urinary tract TCC

A

5% of all malignancies of upper urinary tract.

25
Q

What are initial investigation for suspected Upper urinary tract TCC?

A
  • Ultrasound
  • CT Urogram (Filling defect, Ureteric stricture)
  • Retrograde pyelogram
  • Ureteroscopy (Biopsy, Washings for cytology)
26
Q

What is the standard treatment for upper urinary tract TCC?

A

-Nephro-ureterectomy

27
Q

What is the treatment for metastatic TCC?

A

-Systemic chemotherapy (Traditionally cisplatin-based but needs reasonable kidney function for this to happen

-Biological therapies
Immunotherapy (New)

28
Q

Describe the biological therapy used in metastatic TCC.

A

Cancer cells employ a protective mechanism to avoid destruction by the immune system

  • One anti-TCC strategy is to introduce antibodies to block this protective mechanism
  • Targeting the Programmed Cell Death Receptor 1 (can be given in the presence of poor renal function
29
Q

Describe the epidemiology of Prostate Cancer.

A
  • Commonest cancer in men
  • 2nd most common cause of death from cancer in men
  • Rare in men lower than 50 years of age
30
Q

What are risk factors for prostate cancer?

A
  • Age
  • Family history (BRCA2 gene mutation)
  • Ethnicity (Black>white>Asian)
31
Q

Describe screening for prostate cancer.

A

PSA screening

  • Enzyme
  • If it is higher doesn’t means prostate cancer
  • If it is low/normal doesn’t mean you do not have prostate cancer
  • Cant rely on PSA within 6 weeks of a urinary retention
  • You need glands to make PSA. If they are replaced by the cancer then you can’t make it
32
Q

What the issue with PSA screening

A
  • Over diagnosis -
  • Over treatment
  • QOL (co-morbidities of established treatment. Our screening isn’t good enough)
  • Cost-effectiveness
  • Other causes of raised PSA (Infection, Inflammation, Large prostate, Urinary retention)
33
Q

What is the presentation of prostate cancer?

A
  • Urinary symptoms
  • Bone pain – spread to bone
  • Had their PSA check then biopsied
  • DRE for another reason – change in bowel habit
  • Incidental finding at transurethral resection of prostate (TURP) for retention/urinary symptoms
34
Q

Why do patient with prostate cancer experience bone pain?

A
  • Bone metastases
  • Sclerotic as it is osteoblastic
  • Hot spots on bone scan
  • Highly unlikely if PSA <10 ng/ml)
35
Q

What is the diagnostic pathway for prostatic cancer?

A
  • DRE
  • Serum PSA (If abnormal for the previous : Transrectal ultrasound guided bipsy of prostate)
  • LUTS tract symptoms (Transurethreal resection of prostate)
36
Q

What is the treatment for local prostate cancer?

A
  • Established Rxs (Surveillance, Robotic radical prostatectomy)
  • Radiotherapy (External beam, Brachytherapy)
37
Q

What is the treatment for locally advanced prostate cancer?

A
  • Surveillance (Rapid rise in PSA)
  • Hormones
  • Hormones and radiotherapy
38
Q

What are the treatment types for hormones and palliation?

A
  • Hormone (+-chemotherapy)

- Palliation

39
Q

What are the types of hormonal treatments for metastatic prostate cancer?

A
  • Surgical castration

- Medical castration using LHRH agonists to decrease testosterone

40
Q

Describe the palliative treatment for metastatic prostate cancer?

A
  • Single dose radiotherapy
  • Bisphosphonates
  • Zoledronic acid (Chemotherapy )
  • New treatments (eg abiraterone, enzalutamide)
41
Q

What are factors affecting treatment decisions for prostate cancer?

A
  • Age
  • DRE (Localised, Locally-advanced, Advanced)
  • PSA level
  • Biopsies (Gleason grade, Extent)
  • MRI scan and bone scan (Nodal and visceral metastases)
42
Q

What is acute polycystic kidney disease?

A
  • Autosomal dominant (+new mutations)
  • Mutation in PKD 1 gene and PKD 2 gene
  • Cysts grow with age generally presents in adulthood
  • Big kidneys
  • Diagnosed with ultrasound and Genetic testing
43
Q

What are secondary complications from cyst in APCKD?

A
  • Pain
  • Bleeding into cyst
  • Infection
  • Renal stones)
44
Q

What is the clinical disease in APCKD?

A
  • Cyst fluid filled
  • Hypertension very common
  • Increase incidence of intra-cranial aneurysms
  • Increased incidence of heart valve abnormalities

Kofi: Pure Clinical Sem 3 (44 decks)

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