urological cancers

Question 1

what is renal cell carcinoma

Answer 1

tumor of the renal parenchyma

Question 2

red flag presentation of urological cancers

Answer 2

haematuria
testicular lump
penile mass or ulcerated or persistent lesion

Question 3

DDx of haematuria

Answer 3

Cancer
 Renal cell carcinoma (RCC)
 Upper tract TCC
 Bladder carcinoma
 Advanced prostate carcinoma

Other
 Stones
 Infection
 Inflammation
 Benign prostatic hyperplasia
(large)

Question 4

testicular lump what do u do

Answer 4

 Lump in body of testis (usually painless)
 Suspect testis cancer!

Refer via 2 week wait to Urology
 Urgent ultrasound of scrotum to confirm
diagnosis
 Check testis tumour markers if testicular mass on
ultrasound (aFP, hCG, LDH)

Germ cell tumours (Seminoma/Teratoma) usually
in men aged <45 yrs
 Risk – history of undescended testis.
 Older men (Could be lymphoma)
 Treatment
 Inguinal orchidectomy is the 1st treatment

Question 5

RFs of bladder TCC

Answer 5

M>F
cacucasian

smoking
Occupational exposure (20 yr latent period)
 Rubber or plastics manufacture (Arylamines)
 Handling of carbon, crude oil, combustion, smelting
(Polyaromatic hydrocarbons)
 Painters, mechanics, printers, hairdressers

Question 6

Mx of muscle invasive bladder TCC

Answer 6

curative
- neoadjuvant chemo + radical cystectomy/radiotherapy

palliative -> palliative chemo/radio

Question 7

Mx of bladder TCC

Answer 7

low risk non muscle invasice
- check cystoscopies

intermediate/high risk
- cystoscopies/intravesical chemotherapy/immunotherapu

Question 8

Mx of metastatic TCC

Answer 8

• systemic chemo - cisplatin based

- biologics - immunotherapy - to introduce ABs to block this protective mechanism - atezolizumab

Question 9

Mx of upper urinary tract TCC

Answer 9

nephro - ureterectomy

Question 10

epidemiology and presentation of RCC

Answer 10

Presentation
 Haematuria
 Incidental finding on imaging
 Palpable mass – Rare!

white>non white

aetiology
- Smoking (2x↑)
 Obesity
 Dialysis

Question 11

Mx

localised

metastactic

Answer 11

Surveillance
 Excision
- Radical
nephrectomy
-> Open
-> Laparoscopic
- Partial
nephrectomy
-> Open
-> Robotic

metastatic
Palliative
 Biological therapies
 Targeted therapies
 Those targeting angiogenesis are now 1st choice
 e.g Sunitinib, sorafenib, pazopanib