urinary cancers Flashcards
What is epidemiology of kidney cancer?
Increasing incidence and mortality
What are the types of kidney cancer and how common are they?
Most common renal cell carcinoma (adenocarcinoma).
Then transitional cell carcinoma.
-Rest are other (sarcoma, wilms tumour etc)
What are risk factors for kidney cancer?
Smoking, obesity, hypertension, genetics, renal failure & dialysis
What are the clinical features of kidney cancers? What is the red flag?
- Red flag is painless haematuria/persistent microscopic haematuria.
- Other features of RCC are loin pain, palpable mass, metastatic disease symptoms (bone pain, haemoptysis)
What investigations do you do when painless visible haematuria?
Flexible cytoscopy, CT urogram, renal function tests.
What investigations do you do when persistent non-visible haematuria?
Flexible cytoscopy, US KUB
What investigations for suspected kidney cancer?
CT renal triple phase, staging CT chest, bone scan if symptomatic
How do you TNM stage a renal cell carcinoma?
T1: tumour less or equal to 7cm.
T2: tumour bigger than 7cm.
T3: tumour extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia
T4: tumour beyond perinephric fascia into surrounding structures
N1: met in single regional LN
N2: met in 2 or more regional lymph nodes
M1: distant met
What is the fuhrman grade in renal cell carcinoma?
1=well differentiated, 2=moderate differentiated, 3 & 4 poorly differentiated
What are different managements for kidney cancer?
- Depends on ASA status, comorbidities, lesion classifcation.
1. partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL (von hippel lindau), T1 tumours - up to 7cm)
2. radical nephrectomy.
3. cryosurgery (small tumours and unfit for surgery)
3. receptor tyrosine kinase inhibitors (in metastatic disease)
What is epidemiology of bladder cancer?
Incidence & mortality declining
What are types of bladder cancer and how common are they?
Most are transitional cell carcinoma (urothelial cells inside of bladder), some are squamous cell carcinomas (most where schistomoniasis is endemic), some adenocarcinomas
What are risk factors for bladder cancer?
Smoking, radiation, long-term cathetarization
What are clinical features of bladder cancer? red flag?
- Painless haematuria/persistent microscopic haematuria red flag.
- Bladder cancer - suprapubic pain, lower urinary tract symptoms, metastatic disease symptoms include bone pain & lower limb swelling
What are investigations for painless visible haematuria in bladder cancer?
Flexible cytoscopy, CT urogram, renal function
What are investigations for persistent microscopic haematuria?
Flexible cytoscopy, US KUB
If biopsy proven muscle invasive in bladder cancer what investigations should be done?
Staging investigations
How do you TNM stage bladder cancer?
Ta: non-invasive papillary carcinoma.
Tis: carcinoma in situ.
T1: invades sub-epithelial connective tissue.
T2: invades muscularis propria.
T3: invades perivesical fat.
T4: invades prostate, uterus, vagina, bowel, pelvic or abdominal wall.
N1: 1 LN below common iliac bifurcation.
N2: more than 1 LN below common iliac bifurcation.
N3 - metastases in common iliac LN.
M1: distant metastases
What are the WHO classifications for differentiation in bladder cancer?
G1: well differentiated. G2: moderate differentiation. G3: poorly differentiated
What is cytoscopy and transurethral resection of bladder lesion? What is risk and purpose?
Uses heat to cut out all visible bladder tumour.
Provides history and can be curative.
Can get bladder perforation.
What is management protocol for bladder cancer?
- non-muscle invasive: if low grade & no carcinoma in situ consider cytoscopic suveillance +/- intravesicular chemotherapy/BCG.
- muscle invasive: cystectomy, radiotherapy +/- chemotherapy, palliative care
What is epidemiology of prostate cancer?
Incidence rising, mortality rates declining
What are types of prostate cancers?
most adenocarcinomas
What are risk factors for prostate cancer?
Increasing age, western nations (scandinavian), ethnicity (african american)
What are clinical features of prostate cancer?
Usually asymptomatic unless metastatic
What are investigations for prostate cancer?
- PSA (prostate specific antigen): prostate specific but not prostate cancer specific (can be high in UTI, prostatis)
- MRI: imaging before biopsy testing. Risk assessment with multiparametric MRI before biopsy and MRI targeted biopsy more superior to previous biopsy testing (transrectal-ultrasonograph guided biopsy).
- trans-perineal prostate biopsy: systematic template biopsies of prostate. Used in most centres over transrectal biopsies as less risk of infection and more able to sample all areas of prostate
How do you TNM stage a prostate cancer?
T1: non-palpable or visible on imaging.
T2: palpable tumour.
T3: beyond prostatic capsule into periprostatic fat.
T4: tumour fixed onto adjacent structure/pelvic side wall. N1: regional LN (pelvics).
M1a - non regional LN.
M1b.: bone.
M1x - other sites
What is the gleason score and its outcomes?
Since multifocal, 2 scores based on level of differentiation (add):
2-6: well differentiated, 7 moderately differentiated 8- poorly differentiated
( nagme: first score gives you the most commonly seen ily x )
What is management for prostate cancer depending on fitness/age and cancer agressiveness?
- if young and fit with high grade cancer - radical prostatectomy/radiotherapy. Young and fit but low grade cancer active surveillance (regular PSA, MRI, Bx). Post prostatectomy monitor PSA 6 monthly (should be undetectable or <0.01ng/ml, if >0.2ng/ml relapse).
- if old/unfit with high grade cancer/metastatic disease do hormone therapy. If low grade watchful waiting with regular PSA testing
What are treatment side effects of prostate cancer?
- Prostate contains proximal sphincter, prostatectomy removes proximal urethral sphincter and changes urethral length (urinary incontinence).
- Risk of damage to cavernous nerves (innervation to bladder and urethra) causes erectile dysfunction and urinary incontinence
Why shift towards imaging prior to biopsy testing?
Random biopsies of prostate were associated with under detection of high grade prostate cancer and over detection of low grade cancer.
Treatment for prostatectomy caused urinary incontinence?
Build pelvic floor muscles via exercise. If fails artificial urinary sphincter device option
Treatment for prostatectomy caused erectile dysfunction?
PDE5 inhibitors, prostaglandin E1 injections & penile prosthesis devices
