urological cancer: prostate, kidney and bladder Flashcards
what is the most common type of kidney cancer
85%-renal cell carcinoma(adenocarcinoma)
10% transitional cell carcinoma
5% - sarcoma/wilms/others
aetiological factors for kidney cancer
genetic factors - von hippel lindau disease smoking obese patients renal dialysis hypertension
clinical features of kidney cancer
painless haematuria/persistent microscopic haematuria = red flag symptom
additional features of rcc:
- loin pain
- palpable mass
- metastatic disease symptoms: bone pain, haemoptysis, hypercalcaemia
investigations for kidney cancer:
- 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
what is flexible cytoscopy
looking into bladder
what might red patches in bladder suggest
carcinoma in situ/ pre cancer
abnormal changes in epithelium
tmn staging for rcc
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
management for kidney cancer
patient specific - depends on asa status, comorbidities, classification of lesion
gold standard is excision via partial nephrectomy
radial nephrectomy
when might you use partial nephrectomy
for single kidney, bilateral tumour, mulitifocal rcc in patients with vhl, t1 tumours
what could you offer to patients with small tumours unfit for surgery
cryosurgery
what might you occur to patients with metastatic disease
receptor tyrosine kinase inhibitors
commonest type of bladder cancer
> 90% of bladder cancer is transitional cell carcinoma, 1-7% squamous cell carcinoma(75% where schistosomiasis is endemic), adenocarcinoma(2%)
aetiology of bladder cancer
smoking
schistosomiasis
utis
clinical features of bladder cancer
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)
investigations for bladder cancer:
painless visible haematuria: flexible cytoscopy, ct urogram, renal function
persistent microscopic haematuria: flexoble cytoscopy, us kub
if biopsy proven muscle invasive then staging investigations
how to stage and grade 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 bifurcation
n2 - > 1 ln below common iliac bifurcation
n3 - mets in a common iliac nm
m1 - distant mets
what does a transurethral resection of bladder involve
uses heat to cut out all visible bladder tumour
provides histology and can be curative
management for non muscle invasive bladder cancer
if low grade and no cis then consideration of cytoscopic surveillance +- intravesicular chemotherapy/bcg
management protocol for muscle invasive bladder cancer
- cystectomy
- radiotherapy
- +/- chemotherapy
- pallative treatment
what is the most common type of prostate cancers
> 95% of prostate cancer is adenocarcinoma
aetiology of prostate cancer
risk factors: increasing age, western nations, ethnicity
clinical features of bladder cancer
usually asymptomatic unless metastatic
prostate cancer investigations
- blood tests - psa is prostate specific but not prostate cancer specific., can be elevated in uti, prostatitis, benign prostatic hyperplasia
- mri
- transperineal prostate biopsy
why is an mri useful in prostate cancer investigation
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
what is transperineal prostate biopsy
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
tnm staging of bladder cancer
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
how to manage cancer in patients who are young and fit with high grade cancer
radical prostatectomy/radiotherapy
how to manage prostate cancer in patients who are young and fit with low grade cancer
active surveillance
regular psa,mri and bx
how to manage cancer in patients who are old and unfit with high grade cancer
hormone therapy
how to manage cancer in patients who are old and unfit with low grade cancer
watchful waiting and regular psa testing
what should be monitored post prostatectomy
monitor psa
if >0.2 ng/ml then relapse
treatment side effects of prostate surgery
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
what should all patients experiencing painless visible haematuria
all patients should undergo cytoscopy and imaging
what should be offered to patients with suspected prostate cancer
should undergo mri
