Uro- oncology

Question 1

List some risk factors for bladder cancer:

Answer 1

Age >80 years old

Caucasians

Chronic inflammation
- schistosomiasis

Drugs

• phenacitin
• cylophosphamide

Pelvic radiotherapy

Occupations

• rubber industry
• Hydrocarbons in the rubber

SMOKING
- 30-50% of causes

Question 2

What are the typical symptoms of bladder cancer?

Answer 2

Painless frank Haematuria

*anyone over 65 with frank haematuria should be checked for bladder cancer
this is done by:

• Cystoscopy

Question 3

What are the types of cancer that present in bladder cancer?

Answer 3

Transitional Cell Carcinoma

• superficial - 75%
• invasive - 25%

Squamous cell

Adenocarcinoma

Question 4

Outline the staging of bladder cancer:

Answer 4

T1 - superficial

T2 - further invasion into the bladder structure

T3 - invading into the outer muscle of the bladder

T4 - Invading into neighbouring structures, namely rectum

Question 5

What is the treatment for bladder cancer?

Answer 5

Diagnosed by cystoscopy

*Transurethral resection of bladder tumour

Intravesical Mitomycin given

Cystectomy
- usually done after 6 weeks of mitomycin

Cystectomy
- performed first if if T2-4 (invading through the muscle)
+
Radiotherapy

Question 6

Where are bladder cancers likely to metastasis too? and how is it treated?

Answer 6

Pulmonary

Chemotherapy:
- M- VAC

*methotrexate
Vinblastine
doxorubicin
Cisplatin

Question 7

What are the main types of renal cancers?

Answer 7

Renal Cell Carcinoma

Transitional Cell Carcinoma

Sarcoma

Question 8

What are some risk factors for Renal Carcinoma?

Answer 8

Smoking

Obesity

Hypertension

Renal cystic disease

Haemodialysis

Von Lippue disease

Question 9

What is the presentation of renal cancer?

Answer 9

Majority are incidental

• night sweats
• fever
• fatigue
• weight loss
• haemoptysis
• mass
• pain
• Haematuria

*varicocele

Question 10

What are some common paraneoplastic effects of kidney cancer?

Answer 10

Polycythemia
- increased EPO

Hypercalcaemia

• PTHrP
• Osteolytic lesion of bone

Hypertension
- Renin release

Stauffer’s syndrome
- hepatotoxic effect from substances released from the tumour

Question 11

How is renal cancer diagnosed?

Answer 11

Ultrasound

FBC
LFTs
CRP
Bone profile

CT/ MRI
- to assess the vessels

Renal Biopsy

Question 12

What is the typical histology of renal cancers?

Answer 12

Clear cell - 80%

Question 13

What are the stages of renal cancer, and why is it important to reduce the stage prior to surgery?

Answer 13

T1 - kidney
T2 - kidney

T3a - renal vein
T3b - IVC below diaphragm
T3c - IVC - above diaphragm

T4 - into the heart or adrenal gland

downgrading is essential for making it opperatively safe - considering you arein the IVC

Question 14

What is the treatment of Kidney cancer?

Answer 14

Small Mass:

• Nephron sparing surgery
• cryotherpay

Large Renal
- radical nephrectomy
usually spare the adrenal gland

Question 15

What are the indications for nephron sparing surgery?

Answer 15

Single kidney

CKD - monitored by eGFR

CV risk factors

pT1a tumours

Question 16

What are the risk factors for testicular cancer:

Answer 16

20 - 45 years old

Cryptorchidism

HIV

Caucasian

Question 17

How does testicular cancer present?

What investigations are done?

Answer 17

Painless lump

*scrotal ultrasound

• alpha fetoprotein
• Teratomas
• Yolk sac tumours

Beta hCG 40% - -
- teratoma

LDH
- Seminoma

Question 18

What the most common tumours of the testicle>

Answer 18

Seminoma

Teratoma

Mixed

Yolk Sac

Question 19

Treatment for Testicular cancer:

Answer 19

Radical Orchiectomy

Chemotherapy

Para-aortic nodal therapy
- if spread

Question 20

What are the risk cancers for Penile cancer?

and what are the treatment options?

Answer 20

HPV lesions

circumcision
topical treatment
penectomy
chemo- radiotherapy