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Met 3b > Urological Cancer > Flashcards

Urological Cancer Flashcards

1
Q

Most common–> least common

A 
Prostate
Renal
Testicular
Bladder
Penile
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2
Q

Renal cell cancer epidemiology

A

7000 per year

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3
Q

Renal cell cancer RFs

A 
Men>women (1.5x)
Smoking (1.4-2.3x)
Renal failure + dialysis (x30)
Hypertension (1.4-2x)
Obesity
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4
Q

Renal cell carcinoma genetic factors

A

Von Hippel Lindau (VHL) syndrome- around 50% develop RCC

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5
Q

Renal tumours- histological subtypes

A

Clear cell carcinoma (80%)- VHL mutation seen
Papillary type 1 +2 (10-15%)
Chromophobe (5%)
Rare forms- collecting duct, medullary cell

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6
Q

Renal cell carcinoma presentation

A

50% no symptoms- incidentally diagnosed

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7
Q

Renal cell carcinoma- symptomatic

A 
Haematuria (50%)
Flank pain (40%)
Mass (30%)
Sign of metastases (25%)- bone pain, anorexia, pyrexia of unknown origin
Acute varicocele
Lower limb oedema
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8
Q

Renal cell carcinoma- classic triad

A

Macroscopic haematuria
Palpable mass
Flank pain <10%

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9
Q

Renal cell carcinoma- Investigations

A 
Renal ultrasound
CT of abdo with contrast
CT chest
Bone scan
Ultrasound scan renal tract
Bloods- FBC/U+E/Calcium/LFT
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10
Q

Renal cell carcinoma management

A

Localised- radical or partial nephrectomy (open, laparoscopic)
Locally advanced- Radial nephrectomy + adjuvant treatment
Metastatic- Immunotherapy

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11
Q

Renal cell carcinoma prognosis

A 
Depends on staging:
-Organ-­‐confined T1: 70-­‐94%	
Organ-­‐confinedT2: 65-­‐75%	
Locallyadvanced T3: 40-­‐70%	
N1: 40-­‐70%	
Locally advanced T4,N2 or M1:10-­‐40%
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12
Q

Bladder cancer- epidemiology

A

2nd most common urological malignancy

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13
Q

Bladder cancer RFs

A

Men>women (2.5x)
Increasing age
Smoking (2-5x)
Occupation (rubber/paint and dye manufacture)
Chronic inflammation of bladder mucosa
Schistosomiasis (squamous cell carcinoma)

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14
Q

Malignant bladder tumours

A

Transitional cell carcinoma- >90%
Squamous cell carcinoma- 1-7%
Adenocarcinoma 2%

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15
Q

Bladder tumour clinical presentation

A

Painless macroscopic haematuria (85%)- age>50 34% have TCC bladder, age<50 10% have TCC bladder
Microscopic haematuria- age>50 7-13% have TCC, age<50 5% have TCC
LUTS
UTIs
Pain
Lower limb swelling

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16
Q

Bladder cancer- persistent microscopic haematuria (2 of 3 dipstick tests) or macroscopic haematuria

A

Must be investigated
Renal function, urine microscopy + culture, consider glomerulonephritis screen
Intravenous Urogram (IVU)
Ultrasound renal tract
Flexible cystoscopy
Urine cytology
CT urogram more recently in place of IVU and USS

17
Q

Bladder cancer pathology

A

Papillary- 70%
Mixed papillary + solid- 10%
Solid- 10%
Carcinoma in situ- 10%

18
Q

Bladder cancer staging- based on

A

Histology following transurethral resection of bladder tumour- superficial, muscle-invasive
CT or MRI pelvis
CXR
Bone scan

19
Q

Bladder cancer management

A

Initial TURBT- curative 70% (30% recur- check cystoscopy 3 months)
Adjuvant treatment- Intravesical Mitomycin (MMC) (reduced recurrence rate, prevents implantation, maybe cytotoxic and regress small tumours), Intravesical BCG (stimulates immune system in bladder wall which attack cancer cells)

20
Q

Muscle invasive Bladder TCC

A 
Radial cystectomy + urinary diversion
Radical external beam radiotherapy
Metastatic disease (25% 5 yr survival)- chemo + radio
21
Q

Prostate cancer epidemiology

A

Most commonly diagnosed male cancer

Lifetime risk 1/12

22
Q

Prostate cancer RFs

A

high fat diets

Smoking

23
Q

Prostate carcinoma pathology

A 
Adenocarcinoma- 95%
--> Peripheral zone- 75%
--> transition zone 20%
--> central zone 5%
Prostatic sarcomas (rare)
24
Q

Prostate cancer symptoms

A 
Majority asymptomatic- may be detected by PSA
Symptoms generally reflect extent of disease
LUTS
Haematospermia/haematuria
Perineal discomfort
lower limb swelling
Anorexia + weight loss
Bone pain/pathological fractures
25
Q

PSA

A

Glycoprotein enzyme produced by prostatic epithelial cells

Normal range varies with age, but generally <4ng/ml

26
Q

PSA other causes increase

A 
BPH
Prostatitis
DRE
Urethral catherization
UTI
Prostatic biopsy
27
Q

Gleason scare

A

Prostate cancer graded 1-5 according to gland forming differentiation
Most common histological pattern seen + highest grade of tumour histology seen
Well differentiated- 2-4
Moderate- 5-7
Poor- 8-10

28
Q

Management localised prostate cancer

A

Radical prostatectomy (not transurethral resection of prostate)- open, laparoscopic, robot-assisted laparoscopic
Radical external beam radiotherapy
Brachytherapy (radioactive seeds in prostate)
Cryotherapy

29
Q

Management advanced prostate cancer

A

Androgen deprivation therapy:
Surgical castration- bilateral orchidectomy
Medical castration- LH-RH agonist e.g. Goserelin
Anti-androgen monotherapy

30
Q

Testicular cancers RFs

A

Race- increased if Caucasian (3x) compared to Afro-Caribbean
Un-descended testes- increases risk 3-14x
HIV infection
1st degree relative

31
Q

Testicular cancer- pathology

A

Germ cell tumours 90%- seminoma, non-seminoma
Non germ cell tumours- sex cord stromal tumours 3% (Leydig cell, Sertoli cell)
Other 7%- lymphoma, adenomatoid

32
Q

Testicular cancer presentation

A

Painless scrotal lump

5% acute scrotal pain- intra-tumoural haemorrhage

33
Q

Testicular cancer investigations

A

Testicular ultrasound- hypoechoic region distorting normal architecture, microlithiasis
CT abdo + chest: staging
Serum tumour markers- alpha fetoprotein, BHCG, lactate dehydrogenase

34
Q

Testicular cancer staging

A

TNM system

35
Q

Testicular cancer Non seminoma management

A

Non-metastatic- surveillance, adjuvant chemo

Metastatic- chemo (bleomycin, etoposide, cisplatin)

36
Q

Testicular cancer seminoma management

A

Non-metastatic- risk of para-aortical spread is 20%, adjuvant therapy reduces risk <1%- chemo + radio
Metastatic- radio or chemo, retroperitoneal lymph node dissection

Met 3b (21 decks)

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