Urlogical Malignancies Flashcards
What are risk factors for prostate cancer?
Increasing age (rare under 50), family history, ethnicity (African heritage), genetics (e.g BRCA1or2)
How can prostate cancer present?
The majority of cases are asymptomatic, lower urinary tract symptoms (e.g hesitancy, nocturia, frequency, poor stream), bone pain, rarely ejaculatory symptoms (haematospermia)
What is the initial investigation for prostate cancer?
PSA from blood test, DRE is also a crucial examination to do
What imaging is done for prostate cancer?
MRI prostate
How is a biopsy of the prostate taken?
Transperineal biopsy, local anaesthetic used
What are some common causes of raised PSA?
Urinary infection, prostatitis, BPH, prostate cancer, acute urinary retention
What are some disadvantages of PSA as a diagnostic feature of prostate cancer?
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
What factors will influence the treatment decisions for prostate cancer?
Age, PSA, TNM staging from MRI, Gleason grade, Bone scan M stage
Generally what does are the different T levels in TNM staging for prostate cancer?
T1/T2- localised
T3- localised-advanced
T4- advanced
How do metastatic bone lesions from a prostate primary appear on a scan?
Sclerotic lesions
This is because it produces dense osteoblastic lesions
What is the most common type of prostate cancer?
Adenocarcinomas (95%)
Where in the prostate do most tumours occur?
Peripheral zone of the prostate
Where does prostate cancer most commonly metastasise to?
Bone- particularly the spine
What factors determine prognostic risk and management in prostate cancer?
Stage, Gleason grade and PSA level
When would active surveillance be appropriate management?
Low risk, localised PCa
<T2N0M0, Gleason score 6, PSA <10
Why do younger men <70 benefit more from robotic prostatectomy?
Older men are more at risk of erectile dysfunction and incontinence
Does pain associated with haematuria make cancer more or less likely?
Pain is less likely to be cancer, and represents a more inflammatory picture
Does haematuria being visible or non-visible affect risk of cancer?
If visible it is more likely to be cancer and aroun 50% of people who have clots in urine have cancer
If bleeding occurs at the end of micturition what is the most likely cause?
Inflammation
If a patient describes clot in their urine as long and thin where is the likely cause?
Pathology in upper urinary tract as these could be ureter casts
What are some causes of haematuria?
Cancer, infection, bladder stones, glomerulonephritis
What investigations can be done for haematuria?
Dipstick, U+Es, FBC
Flexible cystoscopy
USS 1st line, CT urogram 2nd line
Although presenting in <10% of patients, what is the classic triad of renal cell carcinoma presentation?
Abdominal/loin pain, haematuria and abdominal mass
What is the most common histological type of RCC?
Clear cell
Which histological type of RCC is associated with VHL syndrome?
Clear cell
What are features of Von Hippel-Lindau syndrome?
Slow growing hemangioblastomas develop in brain and spinal cord, other tumours occur in kidney, pancreas and adrenal glands
What are paraneoplastic syndromes associated with renal cell carcinoma?
Hypercalcaemia, polycythaemia, hypertension, stauffers syndrome, pyrexia of unknown origin
Why do patients with renal cell carcinoma get hypercalcaemia?
Bony metastases and RCCs produce parathyroid hormone related peptides
What is stauffer syndrome?
Paraneoplastic hepatic dysfunction syndrome causing abnormal LFTs and hepatomegaly.
What treatment options are available for a T1 tumour less than 4cm?
Partial nephrectomy, surveillance if high surgical risk
What treatment options are available for tumours between 4-7 cm?
Partial or radical nephrectomy
What treatment options are available for RCC tumours >7 cm confined to kidney?
Laparoscopic radical nephrectomy
If a RCC is greater than 10cm or is invading the perirenal fat, what treatment is adviced?
Open nephrectomy
What are some associations/risk factors for RCC?
Smoking, VHL, tuberous sclerosis, only slightly higher incidence with autosomal dominant polycystic kidney disease
