Urinary Tract Cancer Flashcards
State 3 types of Urinary Tract Cancer.
Haematuria - Bladder and Kidney. Prostate Cancer. Testicular Cancer.
Define Haematuria.
Blood in urine may arise from anywhere in renal tract.
How is Haematuria classified?
Visible (15% malignancies). Non-visible (3% have malignancies) - blood not seen visually but found on dipstick.
How is Non-visible Haematuria (NVH) subdivided?
Symptomatic. Asymptomatic.
Consider the 2 main causes of Haematuria.
Bladder. Kidney Cancer.
When should you always refer a Haematuria?
Visible Haematuria (unless if UTI only and cured with antibiotics). If unexplained Haematuria without UTI.
If the patient has an unexplained UTI, you should make a…
Non-urgent referral.
Patients over the age of 45 should be referred for bladder cancer if…
Unexplained visible haematuria without urinary tract infection. Visible haematuria that persists or recurs after successful treatment or urinary tract infection.
Patients over the age of 60 should be referred for bladder cancer if…
Patient has unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.
You should consider a non-urgent referral for bladder cancer in people aged 60 or over when…
Patient has persistent unexplained urinary tract infection.
What would cause the urine to be very dark red?
Myoglobin - associated with muscle destruction.
What would cause the urine to be red/pink?
Beetroot.
What would cause the urine to be orange?
Drugs (Rifampicin).
State a symptom of Haematuria.
Loin pain, lower urinary tract infection. Smoking. Trauma. Drugs - coagulation. Previous history - surgery.
State an investigation of Haematuria.
Upper urinary tract - Ultrasound/X-Ray, CT scan.
Lower urinary tract - Cytoscopy (thin camera to look inside the urethra).
State a cause of Haematuria.
Infection e.g. pyelonephritis (inflammation of the kidney), cystitis (inflammation of the bladder). Stones in kidney/ducts. Foreign bodies e.g. stents. Drugs e.g. anticoagulation, NSAIDs. Prostatic disease. Trauma. Nephrology - nephritis, IgA.
State a nephrology question worth asking when investigating Haematuria.
If eGFR < 60. Proteinuria (urine protein/creatinine ratio). Hypertension. Family history of renal disease.
State the most common types of Bladder Cancer.
Transitional cell carcinoma (urothelial bladder cancer) - most common. Squamous cell bladder cancer. Adenocarcinoma. Sarcoma. Small cell bladder cancer.
State a treatment or bladder cancer.
Non muscle invasive bladder cancer (80%). Muscle invasive bladder cancer (20%).
Define Non Muscle Invasive Bladder Cancer (80%).
Transurethral resection (remove some of the prostate). Adjuvant intravesical therapy (also called Bacillus Calmette-Guerin or BCG - intravesical immunotherapy).
What does BCG stand for?
Bacillus Calmette-Guerin.
Give an example of a Muscle Invasive Bladder Cancer (20%).
Radial cystectomy (removal of bladder). Urinary diversion. Radical radiotherapy.
Where does renal cancer emerge from?
Proximal renal tubular epithelium.
State the incidence of Prostate Cancer.
Increases with age. 80% men.
State a risk factor of Prostate Cancer.
Positive family history. Increases testosterone. African-American.
State a symptom of Prostate Cancer.
Nocturia - peeing at night. Weight loss. Pain. Haematuria. Hesitancy.
State a diagnostic technique for Prostate Cancer.
Increased Prostate-Specific Antigen level (30% have cancer). Back passage (PR exam). MRI-exam - multi-parametric magnetic resonance imaging (mpMRI). TRUS biopsy - transrectal ultrasound.
State a treatment of Prostate Cancer.
Radial prostatectomy - if < 70 years. Active surveillance - if > 70 years and low risk. External beam radiation therapy (EBRT) - delivery of targeted radiation beam. Androgen deprivation therapy e.g. cryproterone acetate - reduced levels of testosterone which contribute to prostate cancer.
Define the three types of Androgen Deprivation Therapy.
LHRHa - competitive with LH at the LH receptor to downregulate LHRH via negative feedback to reduce testosterone. LHRH antagonists. Antiandrogens - cyproterone acetate.
What is the purpose of Androgen Deprivation Therapy?
Goal is to reduce levels of male hormones, called androgens, to stop them fuelling prostate cancer cells.
State the incidence of Testicular Cancer.
Common in males (15-35). Germ cell tumours/non germ cell tumours.
State the types of Germ Cell Tumours (95% cases).
Seminomas - found in seminiferous tubules. Non-seminomas - teratomas, embryonal carcinomas, choriocarcinomas, yolk sac tumour.
State the types of Non Germ Cell Tumours.
Leydig and Sertoli Cells.
What do Leydig cells produce?
Testosterone and LH.
What are Sertoli cells used for?
Testic formation. Spermatogenesis.
State what you’d find in a history of Testicular Cancer.
Lump - duration/pain/trauma. General health - weight loss/back pain/ LUTS. Sexual history - history of STIs/HIV. Past medical history - Klinefelter syndrome, Contralateral testicular cancer. Undescended testes. 1st degree relatives. Smoking.
State one thing examined with Testicular Cancer.
Bimanual palpation of the testes. Abdominal examination. Lymph node examination including supraclavicular nodes.
State one differential diagnosis of a scrotal lump.
Varicocele (enlargement of the veins within the testicles). Infection (epididimoorchitis). Testicular rupture. Small (Klinefelters). Neoplasm (abnormal mass of tissue that forms when cells grow and divide).
State an investigation of Testicular Cancer.
Bloods - full blood count/U&E, tumour markers e.g. beta-hCg, LDH, alpha-fetoprotein. Imaging e.g. ultrasound scan, chest X ray/CT scan.
When is alpha feta protein raised?
Non-Seminoma (Teratoma).
When is beta Human Chorionic Gonadotrophin raised?
Non-Seminoma (Teratoma, Choriocarcinoma, Seminoma).
When is Lactate Dehydrogenase raised?
To determine tumour burden.
Why is an Ultrasound used in Testicular Cancer?
100% sensitivity for mass in testicle. Also assesses blood supply, fluid, size, compares both sides.
State a treatment of Testicular Cancer.
Stage 1 - orchidectomy (removal of one/both testicles) radiotherapy.
State non-seminomatous germ cell tumours (NSGCT) therapy.
Bleomycin, etoposide, cisplatin.
Define Radical Orchidectomy.
Surgery to remove a testicle with cancer.
Define a Seminoma.
A type of cancer that begins in germ cells which make sperm in males.
Define the types of Non-Seminoma tumours.
Teratoma. Choriocarcinoma. Yolk sac tumour.
State a lump found in the groin.
Epididymal cysts (contain milky fluid - lie above and below testis).
Hydroceles (fluid within the tunica vaginalis common in younger men).
Epididymo-orchitis. (caused by chlamydia, E. coli. mumps, N gonorrhea).
Varicocele - dilated veins of pampiniform plexus.
Haematocele - blood in tunica vaginalis, following trauma.
Spermatocele - cyst that develops on upper testicle that collects sperm.
Epididymitis - inflammation of the epididymis.
Orchitis - inflammation of one/both testicles.
Indirect inguinal hernia - bulge promotion of tissues in the groin area.
Define an Epididymal cyst.
A contain milky fluid lying above and below testis.
Define a Hydroceles.
Fluid within the tunica vaginalis common in younger men.
Define Epididymo-orchitis.
Inflammation of the epididymis and/or testicle.
State a cause of Epididymo-orchitis.
Chlamydia. E. coli. Mumps. N. Gonorrhea.
State a treatment of Epididymo-orchitis if caused by chlamydia.
Doxycycline.
State a treatment of Gonorrhoea.
Ceftriaxone/Ofloxacin.
Define Varicocele.
Dilated veins of Pampiniform Plexus.
State a symptom of Varicocele.
Dull ache and infertility. Distended scrotal blood vessels.
Define Haematocele.
Blood in tunica vaginalis following trauma (may need drainage).
Define Spermatocele.
Cyst that develops on upper testicle that collects/transports sperm.
Define Epididymitis.
Inflammation of one/both of the Epididymis.
Define Orchitis.
Inflammation of one/both of the testicles.
Define an Indirect Inguinal Hernia.
Bulge/protrusion of tissue in the groin area.
State the difference between a Seminoma and Non-seminoma.
Seminomas tend to grow and spread more slowly than NSGCT. Non Seminomas are very variable in appearance and prognosis and tend to grow more rapidly.
