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Y2 Urology And Renal > Urological Cancer > Flashcards

Urological Cancer Flashcards

1
Q

Outline the risk factors of kidney cancer

A

RISK FACTORS OF KIDNEY CANCER
• Smoking
• Renal failure and dialysis
• Obesity
• Hypertension
• Genetic predisposition with Von Hippel-lindau syndrome (50% of individuals will develop RCC) – more in notes

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2
Q

What are the clinical features of kidney cancer?

A

Painless haematuria/persistent microscopic haematuria = RED FLAG
(can reflect any urological malignancy)
Additional features of RCC include:
Loin pain
Palpable mass
Metastatic disease symptoms e.g. bone pain, haemoptysis

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3
Q

What investigations are conducted when a patient has painless visible haematuria?

A

cystoscopy, CT urogram, Renal function (prognostic to determine if kidneys can survive contrast insult)

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4
Q

What investigations are made when a patient has persistent non-visible haematuria?

A

Flexible cystoscopy, US KUB (non visible is less associated with cancer)

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5
Q

What investigations are made when a patient has suspected kidney cancer?

A

CT renal triple phase (longer scan, better visualisation), staging CT chest, bone scan if symptomatic

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6
Q

What is a CT urogram specifically good at viewing?

A

Ureters

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7
Q

Outline the TNM staging for kidney cancers?

A

TNM staging of RCC
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 LN
N2 – met in ≥2 regional LN
M1- distant met

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8
Q

Outline the Fuhrman grading system for describing kidney cancer

A

Fuhrman grade
1 = well differentiated
2 = moderate differentiated
3 = poorly differentiated
4 = presecence of sarcomatoid/rhabdoid differentation

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9
Q

What is the gold standard management plan for kidney cancer?

A

Gold standard is excision : partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours), radical nephrectomy

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10
Q

In patient with small kidney tumours unfit for surgery what is the first line management?

A

Cryosurgery

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11
Q

What is the management plan for patients with kidney cancer that have metastatic disease?

A

Receptor tyrosine kinase inhibitors, block cell signalling pathway and reduce angiogenesis -> reducing spread

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12
Q

Outline the risk factors for bladder cancer?

A

RISK FACTORS
Smoking
• Occupational exposure - dye industry (aromatic hydrocarbons)
• Chronic inflammation of bladder (bladder stones, schistosomiasis, long term catheter)
• Drugs (cyclophosphamide)
• Radiotherapy

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13
Q

What are the clinical features of bladder cancer?

A

• Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
• Additional Features of bladder cancer include
- Suprapubic pain
- Lower urinary tract symptoms
- Metastatic disease symptoms
> bone pain
> lower limb swelling (local lymph node involvement)

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14
Q

More than 90% of bladder cancer is _______

A

Transitional cell carcinoma

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15
Q

Outline the TNM staging of bladder cancer?

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
N1 – 1 LN below common iliac birufication
N2 - >1 LN below common iliac birufication
N3 – Mets in a common iliac LN
M1- distant mets

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16
Q

When investigating for bladder cancer, what is the next step if biopsy is proven muscle invasive?

A

Staging investigations

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17
Q

What does the management protocol for bladder cancer depend on?

A

Wether it is muscle invasive or non-muscle invasive

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18
Q

What does a rigid cystoscopy in bladder cancer provide?

A

Histology but can also be curative

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19
Q

What is a rigid cystoscopy?

A

cystoscopy + transurethral resection of bladder lesion uses heat (cauterize) to cut out all visible bladder tumour

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20
Q

In a rigid cystoscopy what happens if the tumour extends beyond the muscle?

A

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

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21
Q

Outline the WHO classification of bladder cancer?

A

WHO classification of bladder cancer
G1 = well differentiated
G2 = moderate differentiated
G3 = poorly differentiated

22
Q

Outline the management protocol for non muscle invasive bladder cancer?

A

Non Muscle Invasive
- If low grade and no CIS (carcinoma in situ) then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG
- TB vaccine in bladder, inflammatory response shown to reduce risk of progression of bladder lesion

23
Q

Outline the management protocol for muscle invasive bladder cancer

A

Cystectomy
Radiotherapy
Chemotherapy
Palliative treatment

24
Q

More than 95% of prostate cancers are______

A

Adenocarcinoma

25
Q

Outline the risk factors for prostate cancer?

A

Risk factors for prostate cancer
Age >65
Race (black > native Americans > Asian)
Family history
Diet high in fat
Cadmium and rubber manufacturing
Androgen exposure

26
Q

In general, is bladder cancer symptomatic or asymptomatic?

A

Usually asymptomatic unless metastatic

27
Q

What markers are looked at in blood test for prostate cancer?

A

PSA is prostate-specific but not prostate-cancer specific
- can be elevated in (UTI, prostatitis)
- can be done in community

28
Q

When investigating for prostate cancer, when is MRI imaging done?

A

Prior to biopsy

29
Q

Other than prostate cancer, what else can cause high blood PSA levels?

A

Hyperplasia of prostate
Inflammation

30
Q

Why are biopsies for prostate cancer conducted after MRI?

A

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

31
Q

Why are trans perineal prostate biopsies preferred to transrectal biopsies to investigate prostate cancer?

A

Less risk of infection and able to sample all areas of the prostate

32
Q

Outline the TNM staging for prostate cancer

A

TNM staging of prostate cancer
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

33
Q

Outline the Gleason score grading system for prostate cancer

A

Gleason score – grading
• Since multifocal two scores based on level of differentiation
• above grade 3 = cancer
• use most common grade and highest grade to calculate gleason score (eg. 4 + 3 = 7)
2-6 = Well differentiated (low-grade)
7 = Moderately differentiated (intermediate grade)
8 – Poorly differentiated (high-grade)

34
Q

What is the management protocol for prostate cancer dependent on?

A

Patient age and comorbidities and stage and grade of the prostate cancer

35
Q

If a patient is young and fit with high grade prostate cancer, what is the management plan?

A
36
Q

Is a patient is young and fit but has low grade prostate cancer, what is the management plan?

A
37
Q

Post prostatectomy, what is the management plan?

A
38
Q

If a patient is old/unfit with high grade prostate cancer/ metastatic disease, what is the management protocol?

A
39
Q

If a patient is old/unfit with low grade cancer, what is the management protocol?

A
40
Q

What are the side effects of prostatectomy and treatment of prostate cancer?

A

Urinary incontinence and erectile dysfunction

41
Q

What are the six types of germ cell testicular tumours as classified by WHO?

A

Seminoma
Spermatocytic seminoma
Teratoma differentiated
Embryonal carcinoma
Yolk sac tumour
Choriocarcinoma

42
Q

What are the five types of sex cord/gonadal stromal testicular tumours as classified by WHO?

A

Leydig cell tumour
Sertoli cell tumour
Granulosa cell tumour
Tumours of thecoma/ fibroma group
Mixed tumours

43
Q

What are the three principle serum tumour markers for germ cell testicular tumours?

A

Alpha-fetoprotein (AFP)
Beta subunit of HCG
Lactate dehydrogenase (LDH)

44
Q

Where is AFP normally synthesised?

A

By foetal yolk sac, liver, intestine

45
Q

What is the serum half life of AFP?

A

4.5 days

46
Q

AFP is elevated in which patients?

A

Elevated in patients with yolk sac component within a teratomatous germ cell tumour

47
Q

The beta subunit of HCG is secreted by which cells?

A

Secreted by placental syncitiotrophoblastic cells

48
Q

What percentage of seminomas and all choriocarcinomas produce HCG?

A

10%

49
Q

LDH is a specific tumour marker for?

A

General tumour marker
-Not specific for any particular type of GCT
-Elevation of LDH correlates with tumour burden

50
Q

What are the pathological prognostic factors in stage 1 seminoma?

A

Tumoursize of >4cm
Rete invasion (stromal)

51
Q

What are the pathological prognostic factors in stage 1 non-seminomatous tumours?

A

lymphovascular invasion
- presence (and extent) of embryonal carcinoma

52
Q

What are the symptoms of penile cancer?

A

Inability/ difficulty / pain on retracting foreskin (phimosis – partial/ complete)

•Spraying of stream (meatal stenosis)

•Obstructive LUTS (urethral stricture)

•Association with penile cancer

Y2 Urology And Renal (7 decks)

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