Urinary Tract Cancers Flashcards
State the risk factors of renal cell carcinoma
Male, white, smoking, obesity, dialysis
Describe the presentation of renal cell carcinoma
- Haematuria
- If advanced - large varicocele, pulmonary/tumour embolus, weight loss, loss of appetite, hypercalcaemia
Describe how renal cell carcinoma can spread
- Can spread through the veins and vena cava to the right atrium - pulmonary embolism
- Spread throughout kidney
- Spread through lymph nodes
State the investigations for renal cell carcinoma
- Ultrasound scan
- CT with contrast needed for staging
Describe the treatment of renal cell carcinoma
- Surveillance
- Excision - radical nephrectomy (removal of kidney), partial nephrectomy
- Cryoablation - freeze tissue to kill cancer
- Biological therapies (targeted therapies) - for metastatic RCC
- Target angiogenesis through tyrosine kinase inhibitors
State the risk factors of bladder transitional cell carcinoma
Male, white, smoking, occupational exposure
Describe the presentation of bladder transitional cell carcinoma
- Haematuria
- Urethral obstruction may present with flank pain
- Bladder outlet obstruction and urinary retention
- If advanced - loss of weight/appetite, DVT, lymphoedema
Describe the investigation and treatment of bladder carcinoma
- Investigation
- Ultrasound less likely to detect cancer so endoscope normally done
- Treatment
- Chemotherapy
- Radical cystectomy or radiotherapy depending on patient
- Chemotherapy
Describe the spread of renal transitional cell carcinomas
- Likely to progress to bladder transitional cell carcinoma through ureter
- Same epithelium type
Describe the presentation, investigation and treatment of renal transitional cell carcinoma
- Presentation
- Haematuria
- Loin pain
- Investigations
○ Ultrasound scan shows hydronephrosis- CT with contrast
- Retrograde pyelogram - contrast injected into patient
- Ureteroscopy - biopsy
- Treatment
- Nephro-urectomy
- Removal of kidney, ureter and cuff of bladder (vesico-ureteric junction + small amount of bladder)
Describe the treatment of metastatic transitional cell carcinoma
- Systemic chemotherapy - need reasonable kidney function
- Biological therapies - immunotherapy
- Antibodies to target protective mechanism of cancer cells
Are visible or non-visible haematuria more likely to be due to cancer
- Visible haematuria not due to UTI needs referral - could be urinary tract carcinoma
- Non-visible haematuria less likely to be urinary tract carcinoma
List potential causes of haematuria
- Cancer - RCC, bladder cancer, upper urinary tract UCC, advanced prostate carcinoma
- Stones, infection, inflammation, BPH
- Glomerular causes
Describe the assessment of haematuria patients
- Painless presentation less likely to be stones/infection and thus more likely to be cancer
- Blood pressure
- Abdominal mass
- Varicocele
- Leg swelling - DVT, lymphoedema
- Assess prostate size and texture
List the investigations for a patient with haematuria
- Radiology - ultrasound to look for tumour, stones
- Urine
- Endoscopy
- Bloods
What area of the prostate does cancer commonly occur in
Peripheral zone
What are risk factors of prostate caner
- Increasing age
- Family history
- Has links with BRCA2 gene mutation
- Ethnicity - black > white > Asian
Describe the presentation and investigations for prostate cancer
- Presentation
- Urinary symptoms
- Bone pain metastases - back pain
- Investigations
- Digital rectal examination and serum PSA testing
- If positive, TRUS (transrectal ultrasound) guided biopsy of prostate
- Only through biopsy can prostate cancer be confirmed unless huge PSA changes
What factors influence prostate treatment
- Age
- DRE - size and location of cancer
- PSA level
- Biopsy - gleason grade score, pleomorphism, nucleus to cytoplasmic ratio
- MRI scan and bone scan for metastases
Describe the treatment for localised prostate cancer
- Localised prostate cancer
- Surveillance
- Radiotherapy
- Robotic radical prostatectomy
- Locally advanced prostate cancer
- Surveillance
- Hormone therapy
- Radiotherapy + hormone therapy
Describe the treatment for metastatic prostate cancer
- Sclerotic lesions rather than lytic - thickening of bone
- Hormone + chemotherapy
- LHRH agonist increases LH and thus testosterone levels
- Reduces the pulsatile nature of GHRH, thus less LH and less testosterone are made overtime
- Palliation - relieving symptoms through radiotherapy, chemotherapy
Describe the results of PSA testing
- PSA is an enzyme which liquefies semen
- A negative PSA testing does not rule out prostate cancer
- A normal PSA but an abnormal feeling prostate and DRE may occur - some patients normally have less glands and produce less PSA
- PSA can be raised physiologically and raised in non-cancerous causes, so over-diagnosis probable
Other than prostate cancer, what other conditions can elevate PSA
- Infection - can’t reply on PSA within 6 weeks of urinary infection
- Inflammation
- Large prostate
- Urinary retention
