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Cancer > Urinary Tract Cancer > Flashcards

Urinary Tract Cancer Flashcards

1
Q

State 3 types of Urinary Tract Cancer.

A

Haematuria - Bladder and Kidney. Prostate Cancer. Testicular Cancer.

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2
Q

Define Haematuria.

A

Blood in urine may arise from anywhere in renal tract.

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3
Q

How is Haematuria classified?

A

Visible (15% malignancies). Non-visible (3% have malignancies) - blood not seen visually but found on dipstick.

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4
Q

How is Non-visible Haematuria (NVH) subdivided?

A

Symptomatic. Asymptomatic.

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5
Q

Consider the 2 main causes of Haematuria.

A

Bladder. Kidney Cancer.

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6
Q

When should you always refer a Haematuria?

A

Visible Haematuria (unless if UTI only and cured with antibiotics). If unexplained Haematuria without UTI.

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7
Q

If the patient has an unexplained UTI, you should make a…

A

Non-urgent referral.

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8
Q

Patients over the age of 45 should be referred for bladder cancer if…

A

Unexplained visible haematuria without urinary tract infection. Visible haematuria that persists or recurs after successful treatment or urinary tract infection.

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9
Q

Patients over the age of 60 should be referred for bladder cancer if…

A

Patient has unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.

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10
Q

You should consider a non-urgent referral for bladder cancer in people aged 60 or over when…

A

Patient has persistent unexplained urinary tract infection.

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11
Q

What would cause the urine to be very dark red?

A

Myoglobin - associated with muscle destruction.

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12
Q

What would cause the urine to be red/pink?

A

Beetroot.

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13
Q

What would cause the urine to be orange?

A

Drugs (Rifampicin).

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14
Q

State a symptom of Haematuria.

A

Loin pain, lower urinary tract infection. Smoking. Trauma. Drugs - coagulation. Previous history - surgery.

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15
Q

State an investigation of Haematuria.

A

Upper urinary tract - Ultrasound/X-Ray, CT scan.

Lower urinary tract - Cytoscopy (thin camera to look inside the urethra).

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16
Q

State a cause of Haematuria.

A

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.

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17
Q

State a nephrology question worth asking when investigating Haematuria.

A

If eGFR < 60. Proteinuria (urine protein/creatinine ratio). Hypertension. Family history of renal disease.

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18
Q

State the most common types of Bladder Cancer.

A

Transitional cell carcinoma (urothelial bladder cancer) - most common. Squamous cell bladder cancer. Adenocarcinoma. Sarcoma. Small cell bladder cancer.

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19
Q

State a treatment or bladder cancer.

A

Non muscle invasive bladder cancer (80%). Muscle invasive bladder cancer (20%).

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20
Q

Define Non Muscle Invasive Bladder Cancer (80%).

A

Transurethral resection (remove some of the prostate). Adjuvant intravesical therapy (also called Bacillus Calmette-Guerin or BCG - intravesical immunotherapy).

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21
Q

What does BCG stand for?

A

Bacillus Calmette-Guerin.

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22
Q

Give an example of a Muscle Invasive Bladder Cancer (20%).

A

Radial cystectomy (removal of bladder). Urinary diversion. Radical radiotherapy.

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23
Q

Where does renal cancer emerge from?

A

Proximal renal tubular epithelium.

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24
Q

State the incidence of Prostate Cancer.

A

Increases with age. 80% men.

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25
Q

State a risk factor of Prostate Cancer.

A

Positive family history. Increases testosterone. African-American.

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26
Q

State a symptom of Prostate Cancer.

A

Nocturia - peeing at night. Weight loss. Pain. Haematuria. Hesitancy.

27
Q

State a diagnostic technique for Prostate Cancer.

A

Increased Prostate-Specific Antigen level (30% have cancer). Back passage (PR exam). MRI-exam - multi-parametric magnetic resonance imaging (mpMRI). TRUS biopsy - transrectal ultrasound.

28
Q

State a treatment of Prostate Cancer.

A

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.

29
Q

Define the three types of Androgen Deprivation Therapy.

A

LHRHa - competitive with LH at the LH receptor to downregulate LHRH via negative feedback to reduce testosterone. LHRH antagonists. Antiandrogens - cyproterone acetate.

30
Q

What is the purpose of Androgen Deprivation Therapy?

A

Goal is to reduce levels of male hormones, called androgens, to stop them fuelling prostate cancer cells.

31
Q

State the incidence of Testicular Cancer.

A

Common in males (15-35). Germ cell tumours/non germ cell tumours.

32
Q

State the types of Germ Cell Tumours (95% cases).

A

Seminomas - found in seminiferous tubules. Non-seminomas - teratomas, embryonal carcinomas, choriocarcinomas, yolk sac tumour.

33
Q

State the types of Non Germ Cell Tumours.

A

Leydig and Sertoli Cells.

34
Q

What do Leydig cells produce?

A

Testosterone and LH.

35
Q

What are Sertoli cells used for?

A

Testic formation. Spermatogenesis.

36
Q

State what you’d find in a history of Testicular Cancer.

A

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.

37
Q

State one thing examined with Testicular Cancer.

A

Bimanual palpation of the testes. Abdominal examination. Lymph node examination including supraclavicular nodes.

38
Q

State one differential diagnosis of a scrotal lump.

A

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).

39
Q

State an investigation of Testicular Cancer.

A

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.

40
Q

When is alpha feta protein raised?

A

Non-Seminoma (Teratoma).

41
Q

When is beta Human Chorionic Gonadotrophin raised?

A

Non-Seminoma (Teratoma, Choriocarcinoma, Seminoma).

42
Q

When is Lactate Dehydrogenase raised?

A

To determine tumour burden.

43
Q

Why is an Ultrasound used in Testicular Cancer?

A

100% sensitivity for mass in testicle. Also assesses blood supply, fluid, size, compares both sides.

44
Q

State a treatment of Testicular Cancer.

A

Stage 1 - orchidectomy (removal of one/both testicles) radiotherapy.

45
Q

State non-seminomatous germ cell tumours (NSGCT) therapy.

A

Bleomycin, etoposide, cisplatin.

46
Q

Define Radical Orchidectomy.

A

Surgery to remove a testicle with cancer.

47
Q

Define a Seminoma.

A

A type of cancer that begins in germ cells which make sperm in males.

48
Q

Define the types of Non-Seminoma tumours.

A

Teratoma. Choriocarcinoma. Yolk sac tumour.

49
Q

State a lump found in the groin.

A

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.

50
Q

Define an Epididymal cyst.

A

A contain milky fluid lying above and below testis.

51
Q

Define a Hydroceles.

A

Fluid within the tunica vaginalis common in younger men.

52
Q

Define Epididymo-orchitis.

A

Inflammation of the epididymis and/or testicle.

53
Q

State a cause of Epididymo-orchitis.

A

Chlamydia. E. coli. Mumps. N. Gonorrhea.

54
Q

State a treatment of Epididymo-orchitis if caused by chlamydia.

A

Doxycycline.

55
Q

State a treatment of Gonorrhoea.

A

Ceftriaxone/Ofloxacin.

56
Q

Define Varicocele.

A

Dilated veins of Pampiniform Plexus.

57
Q

State a symptom of Varicocele.

A

Dull ache and infertility. Distended scrotal blood vessels.

58
Q

Define Haematocele.

A

Blood in tunica vaginalis following trauma (may need drainage).

59
Q

Define Spermatocele.

A

Cyst that develops on upper testicle that collects/transports sperm.

60
Q

Define Epididymitis.

A

Inflammation of one/both of the Epididymis.

61
Q

Define Orchitis.

A

Inflammation of one/both of the testicles.

62
Q

Define an Indirect Inguinal Hernia.

A

Bulge/protrusion of tissue in the groin area.

63
Q

State the difference between a Seminoma and Non-seminoma.

A

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.

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