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3 - Urinary > Urinary Tract Cancers > Flashcards

Urinary Tract Cancers Flashcards

1
Q

State the risk factors of renal cell carcinoma

A

Male, white, smoking, obesity, dialysis

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2
Q

Describe the presentation of renal cell carcinoma

A
  • Haematuria

- If advanced - large varicocele, pulmonary/tumour embolus, weight loss, loss of appetite, hypercalcaemia

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3
Q

Describe how renal cell carcinoma can spread

A
  • Can spread through the veins and vena cava to the right atrium - pulmonary embolism
  • Spread throughout kidney
  • Spread through lymph nodes
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4
Q

State the investigations for renal cell carcinoma

A
  • Ultrasound scan

- CT with contrast needed for staging

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5
Q

Describe the treatment of renal cell carcinoma

A
  • 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
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6
Q

State the risk factors of bladder transitional cell carcinoma

A

Male, white, smoking, occupational exposure

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7
Q

Describe the presentation of bladder transitional cell carcinoma

A
  • Haematuria
  • Urethral obstruction may present with flank pain
  • Bladder outlet obstruction and urinary retention
  • If advanced - loss of weight/appetite, DVT, lymphoedema
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8
Q

Describe the investigation and treatment of bladder carcinoma

A
  • Investigation
    • Ultrasound less likely to detect cancer so endoscope normally done
  • Treatment
    • Chemotherapy
      • Radical cystectomy or radiotherapy depending on patient
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9
Q

Describe the spread of renal transitional cell carcinomas

A
  • Likely to progress to bladder transitional cell carcinoma through ureter
  • Same epithelium type
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10
Q

Describe the presentation, investigation and treatment of renal transitional cell carcinoma

A
  • 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)
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11
Q

Describe the treatment of metastatic transitional cell carcinoma

A
  • Systemic chemotherapy - need reasonable kidney function
  • Biological therapies - immunotherapy
    • Antibodies to target protective mechanism of cancer cells
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12
Q

Are visible or non-visible haematuria more likely to be due to cancer

A
  • Visible haematuria not due to UTI needs referral - could be urinary tract carcinoma
  • Non-visible haematuria less likely to be urinary tract carcinoma
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13
Q

List potential causes of haematuria

A
  • Cancer - RCC, bladder cancer, upper urinary tract UCC, advanced prostate carcinoma
  • Stones, infection, inflammation, BPH
  • Glomerular causes
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14
Q

Describe the assessment of haematuria patients

A
  • 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
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15
Q

List the investigations for a patient with haematuria

A
  • Radiology - ultrasound to look for tumour, stones
  • Urine
  • Endoscopy
  • Bloods
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16
Q

What area of the prostate does cancer commonly occur in

A

Peripheral zone

17
Q

What are risk factors of prostate caner

A
  • Increasing age
  • Family history
    • Has links with BRCA2 gene mutation
  • Ethnicity - black > white > Asian
18
Q

Describe the presentation and investigations for prostate cancer

A
  • 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
19
Q

What factors influence prostate treatment

A
  • 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
20
Q

Describe the treatment for localised prostate cancer

A
  • Localised prostate cancer
    • Surveillance
    • Radiotherapy
    • Robotic radical prostatectomy
  • Locally advanced prostate cancer
    • Surveillance
    • Hormone therapy
    • Radiotherapy + hormone therapy
21
Q

Describe the treatment for metastatic prostate cancer

A
  • 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
22
Q

Describe the results of PSA testing

A
  • 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
23
Q

Other than prostate cancer, what other conditions can elevate PSA

A
  • Infection - can’t reply on PSA within 6 weeks of urinary infection
  • Inflammation
  • Large prostate
  • Urinary retention

3 - Urinary (17 decks)

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