urological cancer: prostate, kidney and bladder

Question 1

what is the most common type of kidney cancer

Answer 1

85%-renal cell carcinoma(adenocarcinoma)
10% transitional cell carcinoma
5% - sarcoma/wilms/others

Question 2

aetiological factors for kidney cancer

Answer 2

genetic factors - von hippel lindau disease
smoking
obese patients
renal dialysis
hypertension

Question 3

clinical features of kidney cancer

Answer 3

painless haematuria/persistent microscopic haematuria = red flag symptom
additional features of rcc:
- loin pain
- palpable mass
- metastatic disease symptoms: bone pain, haemoptysis, hypercalcaemia

Question 4

investigations for kidney cancer:

Answer 4

• painless visible haematuria: flexible cytoscopy, ct urogram, renal function
• painless non visible haematuria: flexible cytoscopy, us kub
• if suspected kidney cancer: ct renal triple phase, staging ct chest, bone scan if symptomatic

Question 5

what is flexible cytoscopy

Answer 5

looking into bladder

Question 6

what might red patches in bladder suggest

Answer 6

carcinoma in situ/ pre cancer

abnormal changes in epithelium

Question 7

tmn staging for rcc

Answer 7

t1 <7cm
t2 >7cm
t3 - extends outside kindey but not beyond ipsilateral adrenal/perinephric fascia
t4 - tumour beyond perinephric fascia into surrounding structures
n1 - met in single regional lymph node
n2 - met in >2 regional ln
m1 - distant met

Question 8

management for kidney cancer

Answer 8

patient specific - depends on asa status, comorbidities, classification of lesion
gold standard is excision via partial nephrectomy
radial nephrectomy

Question 9

when might you use partial nephrectomy

Answer 9

for single kidney, bilateral tumour, mulitifocal rcc in patients with vhl, t1 tumours

Question 10

what could you offer to patients with small tumours unfit for surgery

Answer 10

cryosurgery

Question 11

what might you occur to patients with metastatic disease

Answer 11

receptor tyrosine kinase inhibitors

Question 12

commonest type of bladder cancer

Answer 12

> 90% of bladder cancer is transitional cell carcinoma, 1-7% squamous cell carcinoma(75% where schistosomiasis is endemic), adenocarcinoma(2%)

Question 13

aetiology of bladder cancer

Answer 13

smoking
schistosomiasis
utis

Question 14

clinical features of bladder cancer

Answer 14

painless haematuria/ persistent microscopic haematuria is red flag symptom
additional features of bladder:
- suprapubic pain
- lower urinary tract symptoms and uti
- metastatic disease symptoms - bone pain, lower limb swelling
rare - (fistulas = advanced features)

Question 15

investigations for bladder cancer:

Answer 15

painless visible haematuria: flexible cytoscopy, ct urogram, renal function
persistent microscopic haematuria: flexoble cytoscopy, us kub
if biopsy proven muscle invasive then staging investigations

Question 16

how to stage and grade bladder cancer

Answer 16

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 bifurcation
n2 - > 1 ln below common iliac bifurcation
n3 - mets in a common iliac nm
m1 - distant mets

Question 17

what does a transurethral resection of bladder involve

Answer 17

uses heat to cut out all visible bladder tumour

provides histology and can be curative

Question 18

management for non muscle invasive bladder cancer

Answer 18

if low grade and no cis then consideration of cytoscopic surveillance +- intravesicular chemotherapy/bcg

Question 19

management protocol for muscle invasive bladder cancer

Answer 19

• cystectomy
• radiotherapy
• +/- chemotherapy
• pallative treatment

Question 20

what is the most common type of prostate cancers

Answer 20

> 95% of prostate cancer is adenocarcinoma

Question 21

aetiology of prostate cancer

Answer 21

risk factors: increasing age, western nations, ethnicity

Question 22

clinical features of bladder cancer

Answer 22

usually asymptomatic unless metastatic

Question 23

prostate cancer investigations

Answer 23

• blood tests - psa is prostate specific but not prostate cancer specific., can be elevated in uti, prostatitis, benign prostatic hyperplasia
• mri
• transperineal prostate biopsy

Question 24

why is an mri useful in prostate cancer investigation

Answer 24

management paradigm for suspected prostate cancer has shifted to imaging
- historically random biopsies were associated with an under detection of low and high grade prostate cancer

Question 25

what is transperineal prostate biopsy

Answer 25

systematic template biopsies of prostate

widely used in most centres over transrectal biopsies as less risk of infection and able to sample all areas of prostate

Question 26

tnm staging of bladder cancer

Answer 26

t1 - non palpable/visible on imaging
t2 - palpable cancer
t3 - beyond prostatic capsule into periprostatic fat
t4 - tumour fixed onto adjacent structure/pelvic side wall
n1 - regional ln
mla - non regional ln
m1b - bone
m1x - othersites

Question 27

how to manage cancer in patients who are young and fit with high grade cancer

Answer 27

radical prostatectomy/radiotherapy

Question 28

how to manage prostate cancer in patients who are young and fit with low grade cancer

Answer 28

active surveillance

regular psa,mri and bx

Question 29

how to manage cancer in patients who are old and unfit with high grade cancer

Answer 29

hormone therapy

Question 30

how to manage cancer in patients who are old and unfit with low grade cancer

Answer 30

watchful waiting and regular psa testing

Question 31

what should be monitored post prostatectomy

Answer 31

monitor psa

if >0.2 ng/ml then relapse

Question 32

treatment side effects of prostate surgery

Answer 32

prostate contains proximal sphincter
prostatectomy removes proximal urethral sphincter and changes urethral length
risk of damage to cavernous nerves - innervation to bladder and urethra
damage to cavernous nerves cause eating disorder

Question 33

what should all patients experiencing painless visible haematuria

Answer 33

all patients should undergo cytoscopy and imaging

Question 34

what should be offered to patients with suspected prostate cancer

Answer 34

should undergo mri