Urinary Cancers

Question 1

What cancers are found in the urinary system?

Answer 1

Renal cell carcinomas,
Transitional cell carcinomas,
Prostate adenocarcinoma.

Question 2

What type of epithelium do renal cell carcinomas arise from?

As such, where are they found?

Answer 2

Tubular epithelium.

Found in the parenchyma of the kidney.

Question 3

What are risk factors for renal cell carcinoma?

Answer 3

Age (60-70 years),
Dialysis,
Smoking,
Obesity.

Question 4

How may renal cell carcinoma present?

Answer 4

Haematuria.
PTH secretion might lead to hypercalcaemia,
Varicoeles may be found.

Question 5

How are renal cell carcinomas imaged?

Answer 5

Ultrasound or CT,

flexible cystoscopy.

Question 6

How is renal cell carcinoma treated?

Answer 6

Partial or radical nephrectomy with removal of associated adrenal gland and paraaortic lymph nodes. Unforunately very resistant to chemotherapy and radiotherapy.
Medication can be given palliatively to inhibit angiogenesis.

Question 7

How does transitional cell carcinoma present?

Answer 7

Haematuria,
Weight loss, loss of appetite,
Symptoms of obstruction.

Question 8

Where do transitional cell carcinomas most commonly present?

How often he more severe symptoms?

Answer 8

The bladder.

Women.

Question 9

What risk factors are there for bladder TCC?

Answer 9

analgesic misuse,
Exposure to aniline dyes,
Smoking (greatest risk factor).

Question 10

How is bladder cancer diagnosed and treated?

Answer 10

Transurethral resection of bladder tumour +- chemoradiotherapy.
If muscle invasive - cystectomy + radiotherapy.

Question 11

What is intravesical BCG treatment?

Answer 11

Modified BCG vaccine introduced to the bladder to stimulate a host immune response against the cancer

Question 12

What is seeding?

Answer 12

The increased risk of developing bladder TCC after an uper urinary tract TCC. Treated with nephro-ureterectomy.

Question 13

What gene mutation is prostate cancer associated with?

Which zone does it commonly occur in?

Answer 13

BRCA1/2

Peripheral zone.

Question 14

How does prostate cancer typically present?

Answer 14

UTI like symptoms with a hard irregular feeling on digital rectal examination.

Question 15

What tumour marker can be used to identify prostate cancer?

When may it also be raised?

Answer 15

PSA.

Also raised in infection, inflammation of the prostate and urinary retention.

Question 16

Where does prostate cancer commonly metastasise to and what does it cause?

Answer 16

Bone - osteosclerotic lesions. Visible on X-ray.

Question 17

What classification is used to grade prostate cancer?

What is used to stage it?

Answer 17

Gleason classification.

TNM staging.

Question 18

How is prostate cancer treated?

Answer 18

Surgery, hormone therapy, radiotherapy.

Question 19

What types of hormonal treatment can be done for those with prostate cancer?

Answer 19

Surgical castration,
Medical castration with LHRH and GnRH agonists (these initially increase testosterone before dramatically decreasing it).

Question 20

What is poly cystic kidney disease?

Answer 20

Autosomal dominant disease resulting in multiple cysts that develop anywhere in the kidney during childhood. May only become symptomatic in adulthood. Lead to hypertension and CKD.

Question 21

How might polycystic kidney disease present?

Answer 21

Hypertension,
Acute loin pain,
Haematuria,
Often history of traumatic incident causing rupture eg contact sports.

Question 22

Where might cysts be found outside of the kidney in PKD?

Answer 22

The liver

Question 23

What management is there for PKD?

Answer 23

Control of blood pressure with antihypertensives,

Dialysis and renal transplants if CKD develops.