Urological Cancer Flashcards
Outline the risk factors of kidney cancer
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
What are the clinical features of kidney cancer?
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
What investigations are conducted when a patient has painless visible haematuria?
cystoscopy, CT urogram, Renal function (prognostic to determine if kidneys can survive contrast insult)
What investigations are made when a patient has persistent non-visible haematuria?
Flexible cystoscopy, US KUB (non visible is less associated with cancer)
What investigations are made when a patient has suspected kidney cancer?
CT renal triple phase (longer scan, better visualisation), staging CT chest, bone scan if symptomatic
What is a CT urogram specifically good at viewing?
Ureters
Outline the TNM staging for kidney cancers?
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
Outline the Fuhrman grading system for describing kidney cancer
Fuhrman grade
1 = well differentiated
2 = moderate differentiated
3 = poorly differentiated
4 = presecence of sarcomatoid/rhabdoid differentation
What is the gold standard management plan for kidney cancer?
Gold standard is excision : partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours), radical nephrectomy
In patient with small kidney tumours unfit for surgery what is the first line management?
Cryosurgery
What is the management plan for patients with kidney cancer that have metastatic disease?
Receptor tyrosine kinase inhibitors, block cell signalling pathway and reduce angiogenesis -> reducing spread
Outline the risk factors for bladder cancer?
RISK FACTORS
Smoking
• Occupational exposure - dye industry (aromatic hydrocarbons)
• Chronic inflammation of bladder (bladder stones, schistosomiasis, long term catheter)
• Drugs (cyclophosphamide)
• Radiotherapy
What are the clinical features of bladder cancer?
• 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)
More than 90% of bladder cancer is _______
Transitional cell carcinoma
Outline the TNM staging of bladder cancer?
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
When investigating for bladder cancer, what is the next step if biopsy is proven muscle invasive?
Staging investigations
What does the management protocol for bladder cancer depend on?
Wether it is muscle invasive or non-muscle invasive
What does a rigid cystoscopy in bladder cancer provide?
Histology but can also be curative
What is a rigid cystoscopy?
cystoscopy + transurethral resection of bladder lesion uses heat (cauterize) to cut out all visible bladder tumour
In a rigid cystoscopy what happens if the tumour extends beyond the muscle?
if the tumour extends beyond muscle then the resection is incomplete due to the risk of perforating the bladder
Outline the WHO classification of bladder cancer?
WHO classification of bladder cancer
G1 = well differentiated
G2 = moderate differentiated
G3 = poorly differentiated
Outline the management protocol for non muscle invasive bladder cancer?
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
Outline the management protocol for muscle invasive bladder cancer
Cystectomy
Radiotherapy
Chemotherapy
Palliative treatment
More than 95% of prostate cancers are______
Adenocarcinoma
