Uro - Urological Cancers Flashcards
What are the different groups of urological cancers?
→ kidney
→ prostate
→ bladder
→ testicular + penile (much more rare)
What is the epidemiology of kidney cancers like?
→ 13,100 new kidney cancer cases in the UK every year(1)
→ Kidney cancer is the 7th most common cancer in the UK(1)
→ Incidence and mortality rising (2)
What are the different types of kidney cancers + their prevalence?
→ 85% = Renal Cell carcinoma (adenocarcinoma)
→ 10% = transitional cell carcinoma
→ 5% = Sarcoma/Wilms tumour/other types
What are the risk factors for kidney cancers?
→ genetic factors → smoking → obesity → patients on renal dialysis → hypertension
What are the usual clinical signs of kidney cancer?
→ Painless haematuria
→ persistent microscopic haematuria (red flag symptom and can reflect any of these urological malignancies)
→ Loin pain
→ Palpable mass
→ Metastatic disease symptoms –bone pain, haemoptysis
What are the investigations done for kidney cancer if there is painless visible haematuria?
→ flexible cystoscopy
→ CT urogram
→ renal function
What are the investigations done for kidney cancer if there is persistent non-visible haematuria?
→ Flexible cystoscopy
→ US KUB (ultrasound of the kidneys, ureters and bladder)
What are the investigations if kidney cancer is suspected?
→ CT renal triple phase
→ staging CT chest
→ bone scan if symptomatic
How do you stage RCC kidney cancers?
→ 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
→ N1 – Met in single regional lymph node
→ N2 – met in ≥2 regional lymph nodes
→ M1 - distant met
How do you grade kidney cancers via Fuhrman grades?
→ 1 = well differentiated
→ 2 = moderate differentiated
→ 3 + 4 = poorly differentiated
What does kidney cancer management depend on?
Patient specific, depends on:
→ the ASA status (ability to tolerate surgery and anaesthesia)
→ comorbidities
→ classification of lesion (TMN staging)
How is kidney cancer managed?
Gold standard is excision either via:
→ Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)
→ Radical Nephrectomy
How do you treat patients with very small tumours who are unfit for surgery?
cryosurgery
→ tumours are frozen which destroys cancer cells and abnormal tissue
How do you treat the metastatic disease of kidney cancers?
(RTKI) receptor tyrosine kinase inhibitors
What is the prognosis like for kidney cancers?
once staging crosses T3/T4, prognosis gets much worse
What are the consequences of radical nephrectomy?
with both kidneys removed, patient will need to be put on dialysis
What is the epidemiology of bladder cancer?
→ 10,200 new bladder cancer cases in the UK every year
→ Bladder cancer is the 11th most common cancer in the UK
→ Incidence and mortality declining
What are the different types of bladder cancer? What is their prevalence?
→ >90% = transitional cell carcinoma
→ 1-7% = squamous cell carcinoma (75% SCC where schistosomiasis is endemic),
→ 2% = Adenocarcinoma
???? What are the risk factors for bladder cancer?
→ smoking
→ old age
→ UTIs
What is the clinical presentation for bladder cancer?
→ Painless haematuria
→ persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
→ Suprapubic pain
→ Lower urinary tract symptoms
→ Metastatic disease symptoms –bone pain, lower limb swelling
What investigation are done for bladder cancer for painless visible haematuria?
→ Flexible cystoscopy
→ CT urogram
→ Renal function
What investigation are done for bladder cancer for persistent microscopic haematuria?
→ Flexible cystoscopy (often under general anaesthetic as you can do surgery at the same time)
→ transurethral resection of bladder lesion
→ US KUB (ultrasound for kidneys, ureters and bladder)
What’s the next step if biopsy shows muscle invasive bladder cancer?
→ staging investigations need to be done
→ muscle invasive cancer is treated differently to superficial cancers
How are bladder cancers staged?
→ 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
→ N1 – 1 Lymph Node below common iliac birufication
→ N2 – >1 LN below common iliac birufication
→ N3 – Mets in a common iliac LN
→ M1 – distant mets
How are bladder cancers graded?
G1 = well differentiated G2 = moderate differentiated G3 = poorly differentiated
*What is the process of a rigid cystoscopy or transurethral resection of a bladder lesion?
→ transurethral resection of bladder lesion uses heat to cut out all visible bladder tumour
→ provides histology and also can be curative
What differentiates management protocol for bladder cancers?
→ non-muscle (superficial) invasive
→ muscle invasive
What is the management protocol for non-muscle invasive bladder cancer?
→ If low grade and no CIS (carcinoma in situ), then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG
What is the management protocol for muscle invasive bladder cancer?
→ Cystectomy = removal of bladder
→ Radiotherapy (makes it very hard to do surgery after, tissue becomes sticky)
→ +/- chemotherapy
→ Palliative treatment
What is the epidemiology of prostate cancer?
→ 48,500 new prostate cancer cases in the UK every year
→ Prostate cancer is the most common cancer in men within the UK
→ Incidence rising but mortality rates declining
What are the types of prostate cancer and their prevalence?
95% = adenocarcinoma
What are the risk factor for prostate cancer?
→ Increasing age
→ Western nations (Scandinavian countries)
→ Ethnicity (African Americans)
????? What are the main clinical features of prostatic cancer?
→ Usually asymptomatic unless metastatic
→ some may present with
urinary incompetence
hydro something something
What are the blood tests that can be done to investigate prostatic cancer?
look for PSA levels
→ prostate specific antigen is prostate-specific but not prostate-cancer specific
→ Can be elevated in (UTI, prostatitis)
What investigations can be done for prostate cancer?
MRI
Trans perineal prostate biopsy
What is the staging of prostate cancers?
T1 – non palpable or visible on imaging T2 – palpable tumour T3 – beyond prostatic capsule into periprostatic fat T4 – tumour fixed onto adjacent structure/pelvic side wall N1 – regional LN (pelvis) M1a - non regional LN M1b - bone M1x - other sites
What is the grading of prostate cancers?
→ Gleason score → Since multifocal two scores based on level of differentiation → 2-6 = Well differentiated → 7 = Moderately differentiated → 8 – Poorly differentiated
What does prostate cancer management depend on?
→ patient age
→ comorbidities
→ stage and grade of prostate cancer
What is the management for someone young + fit with a high grade prostate cancer?
Radical prostatectomy
Radiotherapy
What is the management for someone young + fit with a low grade prostate cancer?
Active surveillance (Regular PSA, MRI and Bx)
What is the management for someone old / unfit with a high grade prostate cancer + - metastatic disease?
hormone therapy
What is the management for someone old + unfit with a low grade prostate cancer?
Watchful waiting (regular PSA testing)
What should be done post-prostatectomy?
→ monitor PSA ( should be undetectable or <0.01ng/ml). → If >0.2ng/ml then relapse
What are the side effects of prostatectomy? How?
erectile dysfunction:
→ prostate contains the proximal sphincter
→ Prostatectomy removes the proximal urethral sphincter and changes urethral length
→ Risk of damage to cavernous nerves (innervation to bladder and urethra)
→ Damage to cavernous nerves causes ED
