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brs (phase 1b) > (uro-renal) urological cancers - REM > Flashcards

(uro-renal) urological cancers - REM Flashcards

1
Q

in the UK, how common is kidney cancer?

A

kidney cancer is the 7th most common cancer in the UK

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2
Q

what are the types of kidney cancer and their prevalence?

A 
85% = renal cell carcinoma (adenocarcinoma)
10% = transitional cell carcinoma, 
5% = sarcoma/Wilms tumour/other types
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3
Q

what is Von Hippel-Lindau syndrome linked to?

A

genetic predisposition with Von Hippel-Lindau syndrome (approx 50% of individuals will develop RCC)

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4
Q

what is a red flag symptom of kidney cancer?

A

painless haematuria OR persistent microscopic haematuria

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5
Q

which investigations are carried out for painless visible haematuria?

A

flexible cystoscopy
CT urogram
renal function

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6
Q

which investigations are carried out for persistent non-visible haematuria?

A

flexible cystoscopy

US KUB

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7
Q

which investigations are carried out for suspected renal cancer?

A

CT renal triple phase scan
staging CT chest
bone scan if symptomatic (to assess presence of bony mets)

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8
Q

what is a flexible cytoscopy?

A

a routine examination of your bladder which is carried out using a flexible telescope (cystoscope) passed into the urethra and into your bladder

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9
Q

what is a CT urogram?

A

a CT scan and special dye (contrast medium) to look at the urinary system and kidneys

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10
Q

what is a US KUB?

A

ultrasound of the kidneys, ureters and bladder

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11
Q

what is a triple phase renal CT scan?

A

a delayed scan with contrast for improved characterisation and visualisaton of a lesion

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12
Q

explain the TMN staging of renal cell carcinomas

A

staged based on tumour size, metastases, node involvement

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13
Q

explain how renal cell carcinomas are staged based on size in TMN

A

T1 – tumour ≤ 7cm
T2 – tumour >7cm
T3 – extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia
T4 – tumour beyond perinephric fascia into surrounding structures

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14
Q

explain how renal cell carcinomas are stages based on metastases in TMN

A

M1 - distant metastasis/es

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15
Q

explain how renal cell carcinomas are stages based on node involvement in TMN

A

N1 – met in single regional lymph node

N2 – met in ≥2 regional lymph node

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16
Q

how are renal cell carcinomas graded based on differentiation?

A

Fuhrman grading = can inform prognosis and treatment plan

1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated

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17
Q

how is kidney cancer managed?

A 
(is patient specific = comorbidities, lesion classification)
partial nephrectomy
radical nephrectomy
cryosurgery
receptor tyrosine kinase inhibitors
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18
Q

what is a partial nephrectomy and when is it used?

A

excision of only the tumour, while leaving the organ intact and unaffected

  • single kidney
  • bilateral tumour
  • multifocal RCC in patients with VHL
  • T1 tumours (up to 7cm)
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19
Q

what is a radical nephrectomy?

A

resection of the whole kidney

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20
Q

what is a cryosurgery and when is it used?

A

freezing the excision

= in patents with small tumours + unfit for surgery

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21
Q

when are receptor tyrosine kinase inhibitors the choice of treatment for kidney cancer?

A

metastatic kidney cancer

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22
Q

what are the different types of bladder cancer?

A

> 90% = transitional cell carcinoma

1-7% = squamous cell carcinoma (75% SCC where schistosomiasis is endemic)

2% = adenocarcinoma

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23
Q

what are the risk factors for bladder cancer?

A

smoking
(age > 55, male)
occupational exposure to chemicals

drugs (cyclophosphamides)
radiotherapy

chronic inflammation (bladder stones, schistosomiasis, long term catheter)

24
Q

what investigations would you do for a patient with painless visible haematuria?

A

flexible cystoscopy
CT urogram
renal function

25
Q

what investigations would you do for a patient with persistentmicroscopic haematuria?

A

flexible cystoscopy

US KUB

26
Q

what are the two types of bladder cancer?

A

non-muscle invasive

muscle invasice

27
Q

what happens when a biopsy proves muscle-invasive bladder cancer?

A

staging investigations

28
Q

explain the tumour staging in bladder TMN staging

A

Ta – non invasive papillary carcinoma
Tis – carcinoma in situ
T1 – invades subepithelial connective tissue
T2 – invades muscularis propria
T3 – invades perivesical fat
T4 – prostate, uterus, vagina, bowel, pelvic or abdominal wall

29
Q

explain the node staging in bladder TMN staging

A

N1 – 1 LN below common iliac birufication
N2 - >1 LN below common iliac birufication
N3 – Mets in a common iliac LN

30
Q

explain the metastases staging in bladder TMN staging

A

M1 - distant mets

31
Q

explain the WHO classification of bladder cancer

A 
G1 = well differentiated
G2 = moderate differentiated
G3 = poorly differentiated
32
Q

how is a bladder cancer usually treated?

A

cystoscopy + transurethral resection of bladder lesion

= transurethral resection of bladder lesion uses heat to ablate all visible bladder tumour
(provides histology and also can be curative)

33
Q

when can a transurethral resection of a bladder lesion not occur?

A

if the tumour invasion extends beyond muscle then the resection is incomplete due to the risk of perforating the bladder

34
Q

explain the management protocol for non-muscle invasive bladder cancer

A

if no CIS (carcinoma in situ) + low grade bladder tumour then
= cystoscopic surveillance +/- intravesicular chemotherapy/BCG vaccine

35
Q

explain the management protocol for muscle invasive bladder cancer

A

cystectomy
radiotherapy
+/- chemotherapy
palliative treatment

36
Q

what are the types of prostate cancer?

A

> 95% of prostate cancer is adenocarcinoma

37
Q

what are the risk factors for prostate cancer?

A

increasing age

Western nations (Scandinavian countries)

ethnicity (African Americans)

38
Q

what are the clinical features of prostate cancer?

A

usually asymptomatic unless metastatic

39
Q

which marker is elevated in prostate cancer?

A

PSA - prostate-specific antigen

40
Q

why must PSA levels be interpreted cautiously?

A

while PSA is prostate-specific, it is not prostate-cancer specific

= can be elevated in (UTI, prostatitis)

41
Q

how is suspected prostate cancer now managed?

A

imaging prior to biopsy

= risk assessment with multiparametric MRI before biopsy

42
Q

why are biopsies no longer immediately done following suspected prostate cancer?

A

random biopsies of the prostate were associated with an under detection of high grade (clinically significant) prostate cancer and over detection of low grade (clinically insignificant) prostate cancer

43
Q

what type of biopsy is done of the prostate for suspected prostate cancer and why?

A

(following the multiparametric MRI)

trasnperineal prostate biopsy

= less risk of infection and able to sample all areas of the prostate

44
Q

explain the tumour staging in prostate TMN staging

A

T1 – non palpable or visible on imaging

  • T1a = in less than 5% of removed tissue
  • T1b = in more than 5% of removed tissue
  • T1c = found by biopsy after e.g. raised PSA

T2 – palpable tumour (completely inside the prostate gland)

  • T2a = half of one side
  • T2b = more than half of one side, not both
  • T2c = both sides

T3 – beyond prostatic capsule into periprostatic fat

  • T3a = broken through prostatic capsule
  • T3b = spread to seminal vesicles

T4 – tumour fixed onto adjacent structure/pelvic side wall (spread to other organs)

45
Q

explain the node involvement in prostate TMN staging

A

N0 - has not spread to nearby LNs

N1 – regional LN (pelvis)

46
Q

explain the tumour staging in prostate TMN staging

A

M0 - cancer has not spread

M1 = cancer has spread to other body parts

  • M1a- non regional LN outside pelvis
  • M1b- bone
  • M1x- other sites
47
Q

which grading scale is used to score prostate cancer?

A

Gleason score

2-6 = well differentiated
7 = moderately differentiated
8 = poorly differentiated
48
Q

what does prostate cancer management depend on?

A

highly dependent on patient age/comorbidities and stage and grade of prostate cancer

49
Q

how is high grade prostate cancer in a young, fit male managed?

A

radical prostatectomy or radiotherapy

50
Q

how is low grade prostate cancer in a young, fit male managed?

A

active surveillance (monitor PSA, MRI)

51
Q

how is high grade prostate cancer in an old, unfit male managed?

A

hormone therapy

52
Q

how is high grade prostate cancer in an old, unfit male managed?

A

watchful waiting (Regular PSA testing)

53
Q

explain the possible complications of a prostatectomy

A

prostatectomy = removes the proximal urethral sphincter so

1) possible risk of inadvertent damage to the cavernous nerve to the prostate (which provides neural innervation to the bladder and urethra) + reduction in urethral length = urinary incontinence
2) damage to cavernous nerves = erectile dysfunction

54
Q

what is the main treatment for urinary incontinence caused by a prostatectomy?

A
  • pelvic floor muscle exercises

- artificial urinary sphincter device

55
Q

what is the required follow-up after a prostatectomy?

A

monitor PSA levels every 6 months

= should be undetectable or <0.01 ng/ml

(a biochemical relapse is defined as a PSA >0.2ng/ml)

56
Q

what should patients that present with haematuria undergo?

A

red flag symptom- all patients should undergo cystoscopy and imaging

brs (phase 1b) (71 decks)

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