Urinary Tract Malignancies Flashcards
What is a RCC?
Renal cell carcinoma
Most common type of kidney tumour
Type of adenocarcinoma that arises from the proximal renal tubular epithelium
What is the classic triad of RCC?
Haematuria
Flank pain
Palpable mass
What is the presentation of RCC?
Asymptomatic 50/%
Haematuria
Loin pain
Weight loss, fatigue, anorexia, night sweats
Palpable renal mass
What is a Wilm’s tumour?
Specific type of renal tumour in children typically under 5
Nephroblastoma
presents with abdominal mass and haematuria
What are the paraneoplastic features of RCC?
Polycythaemia
Hypercalcaemia
HTN
Stauffer’s syndrome- abnormal LFTs
What is the surgical management of RCC?
Partial nephrectomy
Radical nephrectomy
What is partial nephrectomy?
Removing part of the kidney
What is radical nephrectomy?
Removing the entire kidney and surrounding tissue and lymph nodes (and possible adrenal gland)
What other procedures can be used to treat RCC?
Arterial embolization
Percutaneous cryotherapy
Radiofrequency ablation
What treatment is not effective in RCC?
Chemo
Radiotherapy
What are the types of bladder cancer?
TCC (90%)
SCC (5%)
Adenocarcinoma
Sarcoma
Small cell carcinoma
What is TCC?
Transitional cell carcinoma
May arise in the bladder, ureter or renal pelvis
What is the presentation of bladder cancer?
Painless haematuria
Recurrent UTIs
Voiding irritability
What are some risk factors for bladder cancer?
Smoking
Aromatic amines (carcinogen)- dye and rubber industries
Chronic cystitis
Schistosomiasis causes SCC
Pelvic radiotherapy
What is the diagnostic test for bladder cancer?
Cystoscopy with biopsy (histology)
What other tests are used for bladder cancer ?
Urine
CT urogram
MRI
What are the treatment options for bladder cancer?
Transurethral resection of bladder tumour (TURBT)
Intravesical chemotherapy
Radical cystectomy
Chemo or radiotherapy
What are the options for draining urine after radical cystectomy?
Urostomy with ileal conduit- most common
Continent urinary diversion- connect ureters to a pouch with a stoma where you attach a catheter
Neobladder reconstruction- creating a new bladder from ileum
Ureterosigmoidostomy- attach ureters directly to the sigmoid colon
What is the most common cancer in men?
Prostate cancer
What are risk factors for prostate cancer?
Age
FH
Black African or Caribbean
Tall stature
Anabolic steroids
What is the presentation of prostate cancer?
Asymptomatic
LUTS: hesitancy, frequency, weak flow, dribbling, nocturia
Haematuria
Erectile dysfunction
What is the diagnostic for prostate cancer?
PSA- produced by epithelial cells of prostate
May lead to early detection of cancer
What is the results of a cancerous prostate examination?
Firm/hard
Asymmetrical
Irregular
Loss of central sulcus
Hard nodule
What is the next step in diagnosis after PSA and examination?
Prostate biopsy:
- Transrectal US guided biopsy (TRUS)
- Transperineal biopsy
What is the management of prostate cancer?
Watchful waiting
External beam radiotherapy
Brachytherapy (radio)
Hormone therapy- reduce androgen levels that stimulate cancer to grow
Radical prostatectomy
What are the options for hormone therapy?
Androgen receptor blockers
GnRH agonists
From where does testicular cancer arise?
Germ cells in the testes
What are the 2 divisions of testicular cancers?
Seminomas
Non seminomas (mostly teratomas)
What are the risk factors for testicular cancer?
Undescended testes
Male infertility
FH
Increased height
What is the typical presentation of testicular cancer?
Painless lump on testicle
What investigations are carried out for testicular cancer?
Scrotal US
Tumour markers
- Alpha fetoprotein
- Beta-hcg
- LDH
Staging CT
What is the management of testicular cancer?
Radical orchidectomy- inguinal incision centred over inguinal canal
Chemo
Radio
Sperm banking
