Urological Cancers Flashcards
What is the most common form of renal cancer?
Renal cell carcinoma
Where does renal cell carcinoma affect?
Renal malignancy arising from renal parenchyma/cortex accounting for 85% of kidney cancers
What are the three types of renal cancers?
Renal cell carcinoma
Transitional cell carcinoma
Sarcoma/Wilmns tumour
How many kidney cancer cases are diagnosed each year?
13,100 cases
What are the main risk factors for kidney cancer?
Smoking Renal failure Dialysis Obesity Hypertension Von Hippel-Lindau syndrome
What are the clinical features of kidney cancer?
Painless haematuria Persistent microscopic haematuria Loin pain Palpable mass Metastatic disease symptom - bone pain, haempopytis s
What is a red flag in kidney cancer?
Persistent microscopic haematuria - reflecting urological malignancies
What initial investigations are conducted in patients with kidney cancer?
Flexible cystoscopy
US KUB (Kidneys, ureter, and urinary bladder)
What is a flexible cystoscopy?
A flexible cystoscopy through the urethra and bladder
What investigations are conducted in patients with suspected renal cancer?
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
What staging is used for RCC?
TNM
A Fuhrman grade 1 for RCC suggests what?
Well differentiated
A Fuhrman grade 2 for RCC suggests what?
Moderate differentiation
A Fuhrman grade 3+4 suggests what?
Poorly differentiated (4= presence of sarcomatoid/rhomboid differentiation)
What is the first line treatment for RCC?
Partial nephrectomy
What is a partial nephrectomy?
A partial nephrectomy involves the excision of the lesion without comprising the entire organ, given that kidney function is impaired.
What is a radical nephrefctomy?
The resection of the entire kidney
What option is available for patients with small kidney tumours and unfit for surgery?
Cryosurgery
What drug treatment is available for patients with metastatic disease?
Receptor tyrosine kinase inhibitors
What is the most common form of bladder cancer?
Transitional cell carcinoma
What are the three causes of bladder cancer?
TCC
Squamous cell carcinoma
Adenocarcinoma
Which is squamous cell carcinomas of the bladder common in Egypt?
Since schistosomiasis is endemic
What type of variants of bladder cancer is common?
Non-muscle invasive tumours
How are high grade tumours of the bladder shown?
Flat or in-situ, there are difficult to visualise
What treatment for muscle invasive bladder cancer is available?
Radical cystoprostatecetomy
What are the risk factors for bladder cancer?
Smoking (Tobacco) exposure Male gender Age>55 years Exposure to chemical carcinogens Pelvic radiation Systemic chemotherapy
What are the clinical features of bladder cancer?
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
What investigations are conducted in a patient with bladder cancer?
- Flexible cystoscopy
- CT urogram
- Renal function
What does Ta suggest for bladder cancer staging?
Non-invasive papillary carcinoma
What does Tis suggest for bladder cancer staging?
Carcinoma in situ
What does T1 suggest in a patient with bladder cancer?
Invades sub-epithelial connective tissue
A T2 bladder cancer stage suggests what?
Invades muscularis propria
What treatment is conducted in a patient with an initial tumour of the bladder?
A transurethral resection of the bladder - using heat to ablate the visible tumour
Provides histology and is curative
How is a non-muscle invasive tumour treated?
Low grade - and no CIS then consideration of cystoscopic surveillance
BCG vaccine
How can a BCG vaccine treat bladder tumours?
Elicits inflammatory response to reduce the risk of the progression of bladder lesion cancer
What options are available for a patient with a muscle invasive bladder tumour?
• Cystectomy • Radiotherapy • +/- chemotherapy • Palliative treatment -In situ red patches in the bladder are a poor prognostic factor.
What marker is elevated in patients with prostate cancer?
PSA - prostate specific antigen
Under what circumstances i PSA elevated?
Elevated in UTI and prostatitis
What is the recommended investigation for prostate cancer?
MRI prior to biopsy testing
What type of score is given for diagnosis the extensiveness of prostate cancer?
Gleason score
What does a 4+3 tumour suggest?
More likely to grow bilaterally and spread
What risk are associated with a prostatectomy?
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
What is the main treatment for incontinence induced by a prostatectomy?
pelvic floor muscle exercises
Artificial urinary sphincter device if exercises fail
What treatment is available for young and fit patients with a high grade cancer?
Radial prostatectomy
What treatment is available for a patient with a low grade cancer?
Active surveillance (regular PSA, MRI and Bx)
What follow up investigations are conducted to monitor a post-prosatectomy?
Monitor PSA (should be undetectable)
What PSA level indicates a prostate cancer relapse?
> 0.2ng/ml
What treatment is available for a patient who is unfit and has a high grade cancer?
Hormone therapy
What treatment is available for a patient with erectile dysfunction?
Viagra, or prostaglandin E1 and if insufficient - penile prosthesis
