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BRS 1b > Urological Cancers > Flashcards

Urological Cancers Flashcards

1
Q

What is the most common form of renal cancer?

A

Renal cell carcinoma

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2
Q

Where does renal cell carcinoma affect?

A

Renal malignancy arising from renal parenchyma/cortex accounting for 85% of kidney cancers

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3
Q

What are the three types of renal cancers?

A

Renal cell carcinoma
Transitional cell carcinoma
Sarcoma/Wilmns tumour

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4
Q

How many kidney cancer cases are diagnosed each year?

A

13,100 cases

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5
Q

What are the main risk factors for kidney cancer?

A 
Smoking
Renal failure
Dialysis
Obesity
Hypertension 
Von Hippel-Lindau syndrome
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6
Q

What are the clinical features of kidney cancer?

A 
Painless haematuria
Persistent microscopic haematuria
Loin pain 
Palpable mass
Metastatic disease symptom - bone pain, haempopytis s
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7
Q

What is a red flag in kidney cancer?

A

Persistent microscopic haematuria - reflecting urological malignancies

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8
Q

What initial investigations are conducted in patients with kidney cancer?

A

Flexible cystoscopy

US KUB (Kidneys, ureter, and urinary bladder)

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9
Q

What is a flexible cystoscopy?

A

A flexible cystoscopy through the urethra and bladder

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10
Q

What investigations are conducted in patients with suspected renal cancer?

A

CT renal triple phase scan - a delayed scan with contrast for improved characterisation of a lesion
Staging CT chest
Bone scan if symptomatic - identify any bony mets

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11
Q

What staging is used for RCC?

A

TNM

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12
Q

A Fuhrman grade 1 for RCC suggests what?

A

Well differentiated

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13
Q

A Fuhrman grade 2 for RCC suggests what?

A

Moderate differentiation

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14
Q

A Fuhrman grade 3+4 suggests what?

A

Poorly differentiated (4= presence of sarcomatoid/rhomboid differentiation)

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15
Q

What is the first line treatment for RCC?

A

Partial nephrectomy

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16
Q

What is a partial nephrectomy?

A

A partial nephrectomy involves the excision of the lesion without comprising the entire organ, given that kidney function is impaired.

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17
Q

What is a radical nephrefctomy?

A

The resection of the entire kidney

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18
Q

What option is available for patients with small kidney tumours and unfit for surgery?

A

Cryosurgery

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19
Q

What drug treatment is available for patients with metastatic disease?

A

Receptor tyrosine kinase inhibitors

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20
Q

What is the most common form of bladder cancer?

A

Transitional cell carcinoma

21
Q

What are the three causes of bladder cancer?

A

TCC
Squamous cell carcinoma
Adenocarcinoma

22
Q

Which is squamous cell carcinomas of the bladder common in Egypt?

A

Since schistosomiasis is endemic

23
Q

What type of variants of bladder cancer is common?

A

Non-muscle invasive tumours

24
Q

How are high grade tumours of the bladder shown?

A

Flat or in-situ, there are difficult to visualise

25
Q

What treatment for muscle invasive bladder cancer is available?

A

Radical cystoprostatecetomy

26
Q

What are the risk factors for bladder cancer?

A 
Smoking (Tobacco) exposure
Male gender
Age>55 years
Exposure to chemical carcinogens
Pelvic radiation 
Systemic chemotherapy
27
Q

What are the clinical features of bladder cancer?

A

Painless haemturia
Persistent microscopic haemturia –> Red flag (microscopic haematuria is detected using a urine dipstick)
Suprapubic pain
Lower UTI symptoms - increased frequency of urination
Metastatic disease symptoms - bone pain, lower limb swelling, compressional lymph nodes

28
Q

What investigations are conducted in a patient with bladder cancer?

A
  • Flexible cystoscopy
  • CT urogram
  • Renal function
29
Q

What does Ta suggest for bladder cancer staging?

A

Non-invasive papillary carcinoma

30
Q

What does Tis suggest for bladder cancer staging?

A

Carcinoma in situ

31
Q

What does T1 suggest in a patient with bladder cancer?

A

Invades sub-epithelial connective tissue

32
Q

A T2 bladder cancer stage suggests what?

A

Invades muscularis propria

33
Q

What treatment is conducted in a patient with an initial tumour of the bladder?

A

A transurethral resection of the bladder - using heat to ablate the visible tumour
Provides histology and is curative

34
Q

How is a non-muscle invasive tumour treated?

A

Low grade - and no CIS then consideration of cystoscopic surveillance

BCG vaccine

35
Q

How can a BCG vaccine treat bladder tumours?

A

Elicits inflammatory response to reduce the risk of the progression of bladder lesion cancer

36
Q

What options are available for a patient with a muscle invasive bladder tumour?

A 
•	Cystectomy
•	Radiotherapy
•	+/- chemotherapy 
•	Palliative treatment
-In situ red patches in the bladder are a poor prognostic factor.
37
Q

What marker is elevated in patients with prostate cancer?

A

PSA - prostate specific antigen

38
Q

Under what circumstances i PSA elevated?

A

Elevated in UTI and prostatitis

39
Q

What is the recommended investigation for prostate cancer?

A

MRI prior to biopsy testing

40
Q

What type of score is given for diagnosis the extensiveness of prostate cancer?

A

Gleason score

41
Q

What does a 4+3 tumour suggest?

A

More likely to grow bilaterally and spread

42
Q

What risk are associated with a prostatectomy?

A

The prostate contains the proximal sphincteric unit – controls degree of urinary continence.
• A prostatectomy removes the proximal urethral sphincter  Inadvertent damage to the cavernous nerve to the prostate (neural innervation to the bladder and urethra)  bladder function is affected.
• Urethral length changes during operation  Affects continence
• Erectile dysfunction

43
Q

What is the main treatment for incontinence induced by a prostatectomy?

A

pelvic floor muscle exercises

Artificial urinary sphincter device if exercises fail

44
Q

What treatment is available for young and fit patients with a high grade cancer?

A

Radial prostatectomy

45
Q

What treatment is available for a patient with a low grade cancer?

A

Active surveillance (regular PSA, MRI and Bx)

46
Q

What follow up investigations are conducted to monitor a post-prosatectomy?

A

Monitor PSA (should be undetectable)

47
Q

What PSA level indicates a prostate cancer relapse?

A

> 0.2ng/ml

48
Q

What treatment is available for a patient who is unfit and has a high grade cancer?

A

Hormone therapy

49
Q

What treatment is available for a patient with erectile dysfunction?

A

Viagra, or prostaglandin E1 and if insufficient - penile prosthesis

BRS 1b (62 decks)

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