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Cancer Care > Urlogical Malignancies > Flashcards

Urlogical Malignancies Flashcards

1
Q

What are risk factors for prostate cancer?

A

Increasing age (rare under 50), family history, ethnicity (African heritage), genetics (e.g BRCA1or2)

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2
Q

How can prostate cancer present?

A

The majority of cases are asymptomatic, lower urinary tract symptoms (e.g hesitancy, nocturia, frequency, poor stream), bone pain, rarely ejaculatory symptoms (haematospermia)

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3
Q

What is the initial investigation for prostate cancer?

A

PSA from blood test, DRE is also a crucial examination to do

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4
Q

What imaging is done for prostate cancer?

A

MRI prostate

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5
Q

How is a biopsy of the prostate taken?

A

Transperineal biopsy, local anaesthetic used

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6
Q

What are some common causes of raised PSA?

A

Urinary infection, prostatitis, BPH, prostate cancer, acute urinary retention

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7
Q

What are some disadvantages of PSA as a diagnostic feature of prostate cancer?

A

15% of men with PCa will have a normal PSA.
10% of men 50-70 will have a raised PSA
A screening trial found 50% with raised PSA to have clinical insignificant PCa

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8
Q

What factors will influence the treatment decisions for prostate cancer?

A

Age, PSA, TNM staging from MRI, Gleason grade, Bone scan M stage

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9
Q

Generally what does are the different T levels in TNM staging for prostate cancer?

A

T1/T2- localised
T3- localised-advanced
T4- advanced

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10
Q

How do metastatic bone lesions from a prostate primary appear on a scan?

A

Sclerotic lesions
This is because it produces dense osteoblastic lesions

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11
Q

What is the most common type of prostate cancer?

A

Adenocarcinomas (95%)

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12
Q

Where in the prostate do most tumours occur?

A

Peripheral zone of the prostate

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13
Q

Where does prostate cancer most commonly metastasise to?

A

Bone- particularly the spine

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14
Q

What factors determine prognostic risk and management in prostate cancer?

A

Stage, Gleason grade and PSA level

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15
Q

When would active surveillance be appropriate management?

A

Low risk, localised PCa
<T2N0M0, Gleason score 6, PSA <10

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16
Q

Why do younger men <70 benefit more from robotic prostatectomy?

A

Older men are more at risk of erectile dysfunction and incontinence

17
Q

Does pain associated with haematuria make cancer more or less likely?

A

Pain is less likely to be cancer, and represents a more inflammatory picture

18
Q

Does haematuria being visible or non-visible affect risk of cancer?

A

If visible it is more likely to be cancer and aroun 50% of people who have clots in urine have cancer

19
Q

If bleeding occurs at the end of micturition what is the most likely cause?

A

Inflammation

20
Q

If a patient describes clot in their urine as long and thin where is the likely cause?

A

Pathology in upper urinary tract as these could be ureter casts

21
Q

What are some causes of haematuria?

A

Cancer, infection, bladder stones, glomerulonephritis

22
Q

What investigations can be done for haematuria?

A

Dipstick, U+Es, FBC
Flexible cystoscopy
USS 1st line, CT urogram 2nd line

23
Q

Although presenting in <10% of patients, what is the classic triad of renal cell carcinoma presentation?

A

Abdominal/loin pain, haematuria and abdominal mass

24
Q

What is the most common histological type of RCC?

A

Clear cell

25
Q

Which histological type of RCC is associated with VHL syndrome?

A

Clear cell

26
Q

What are features of Von Hippel-Lindau syndrome?

A

Slow growing hemangioblastomas develop in brain and spinal cord, other tumours occur in kidney, pancreas and adrenal glands

27
Q

What are paraneoplastic syndromes associated with renal cell carcinoma?

A

Hypercalcaemia, polycythaemia, hypertension, stauffers syndrome, pyrexia of unknown origin

28
Q

Why do patients with renal cell carcinoma get hypercalcaemia?

A

Bony metastases and RCCs produce parathyroid hormone related peptides

29
Q

What is stauffer syndrome?

A

Paraneoplastic hepatic dysfunction syndrome causing abnormal LFTs and hepatomegaly.

30
Q

What treatment options are available for a T1 tumour less than 4cm?

A

Partial nephrectomy, surveillance if high surgical risk

31
Q

What treatment options are available for tumours between 4-7 cm?

A

Partial or radical nephrectomy

32
Q

What treatment options are available for RCC tumours >7 cm confined to kidney?

A

Laparoscopic radical nephrectomy

33
Q

If a RCC is greater than 10cm or is invading the perirenal fat, what treatment is adviced?

A

Open nephrectomy

34
Q

What are some associations/risk factors for RCC?

A

Smoking, VHL, tuberous sclerosis, only slightly higher incidence with autosomal dominant polycystic kidney disease

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