Urological Cancer Flashcards
Most common–> least common
Prostate Renal Testicular Bladder Penile
Renal cell cancer epidemiology
7000 per year
Renal cell cancer RFs
Men>women (1.5x) Smoking (1.4-2.3x) Renal failure + dialysis (x30) Hypertension (1.4-2x) Obesity
Renal cell carcinoma genetic factors
Von Hippel Lindau (VHL) syndrome- around 50% develop RCC
Renal tumours- histological subtypes
Clear cell carcinoma (80%)- VHL mutation seen
Papillary type 1 +2 (10-15%)
Chromophobe (5%)
Rare forms- collecting duct, medullary cell
Renal cell carcinoma presentation
50% no symptoms- incidentally diagnosed
Renal cell carcinoma- symptomatic
Haematuria (50%) Flank pain (40%) Mass (30%) Sign of metastases (25%)- bone pain, anorexia, pyrexia of unknown origin Acute varicocele Lower limb oedema
Renal cell carcinoma- classic triad
Macroscopic haematuria
Palpable mass
Flank pain <10%
Renal cell carcinoma- Investigations
Renal ultrasound CT of abdo with contrast CT chest Bone scan Ultrasound scan renal tract Bloods- FBC/U+E/Calcium/LFT
Renal cell carcinoma management
Localised- radical or partial nephrectomy (open, laparoscopic)
Locally advanced- Radial nephrectomy + adjuvant treatment
Metastatic- Immunotherapy
Renal cell carcinoma prognosis
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%
Bladder cancer- epidemiology
2nd most common urological malignancy
Bladder cancer RFs
Men>women (2.5x)
Increasing age
Smoking (2-5x)
Occupation (rubber/paint and dye manufacture)
Chronic inflammation of bladder mucosa
Schistosomiasis (squamous cell carcinoma)
Malignant bladder tumours
Transitional cell carcinoma- >90%
Squamous cell carcinoma- 1-7%
Adenocarcinoma 2%
Bladder tumour clinical presentation
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
Bladder cancer- persistent microscopic haematuria (2 of 3 dipstick tests) or macroscopic haematuria
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
Bladder cancer pathology
Papillary- 70%
Mixed papillary + solid- 10%
Solid- 10%
Carcinoma in situ- 10%
Bladder cancer staging- based on
Histology following transurethral resection of bladder tumour- superficial, muscle-invasive
CT or MRI pelvis
CXR
Bone scan
Bladder cancer management
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)
Muscle invasive Bladder TCC
Radial cystectomy + urinary diversion Radical external beam radiotherapy Metastatic disease (25% 5 yr survival)- chemo + radio
Prostate cancer epidemiology
Most commonly diagnosed male cancer
Lifetime risk 1/12
Prostate cancer RFs
high fat diets
Smoking
Prostate carcinoma pathology
Adenocarcinoma- 95% --> Peripheral zone- 75% --> transition zone 20% --> central zone 5% Prostatic sarcomas (rare)
Prostate cancer symptoms
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
PSA
Glycoprotein enzyme produced by prostatic epithelial cells
Normal range varies with age, but generally <4ng/ml
PSA other causes increase
BPH Prostatitis DRE Urethral catherization UTI Prostatic biopsy
Gleason scare
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
Management localised prostate cancer
Radical prostatectomy (not transurethral resection of prostate)- open, laparoscopic, robot-assisted laparoscopic
Radical external beam radiotherapy
Brachytherapy (radioactive seeds in prostate)
Cryotherapy
Management advanced prostate cancer
Androgen deprivation therapy:
Surgical castration- bilateral orchidectomy
Medical castration- LH-RH agonist e.g. Goserelin
Anti-androgen monotherapy
Testicular cancers RFs
Race- increased if Caucasian (3x) compared to Afro-Caribbean
Un-descended testes- increases risk 3-14x
HIV infection
1st degree relative
Testicular cancer- pathology
Germ cell tumours 90%- seminoma, non-seminoma
Non germ cell tumours- sex cord stromal tumours 3% (Leydig cell, Sertoli cell)
Other 7%- lymphoma, adenomatoid
Testicular cancer presentation
Painless scrotal lump
5% acute scrotal pain- intra-tumoural haemorrhage
Testicular cancer investigations
Testicular ultrasound- hypoechoic region distorting normal architecture, microlithiasis
CT abdo + chest: staging
Serum tumour markers- alpha fetoprotein, BHCG, lactate dehydrogenase
Testicular cancer staging
TNM system
Testicular cancer Non seminoma management
Non-metastatic- surveillance, adjuvant chemo
Metastatic- chemo (bleomycin, etoposide, cisplatin)
Testicular cancer seminoma management
Non-metastatic- risk of para-aortical spread is 20%, adjuvant therapy reduces risk <1%- chemo + radio
Metastatic- radio or chemo, retroperitoneal lymph node dissection
