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UROLOGY AND RENAL MEDICINE 2 > UROLOGICAL CANCERS > Flashcards

UROLOGICAL CANCERS Flashcards

1
Q

What types of cancers make up kidney cancer and what are their percentage prevalences?

A

Renal cell carcinoma (adenocarcinoma) - 85%
Transitional cell carcinoma - 10%
Others - 5%

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2
Q

What is the aetiology behind kidney cancers?

A 
Smoking
Obesity
Kidney dialysis
Hypertension
Genetics
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3
Q

What are the clinical features of kidney cancer?

A

Haematuria - main symptom
Loin pain
Palpable mass
Metastatic disease symptoms e.g. bone pain, SOB, Haemoptysis

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4
Q

What investigations should be done with a patient suspected with kidney cancer and is presenting with painless visible haematuria?

A

50-60% have serious pathology

Flexible cystoscopy
CT urogram
Renal function test

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5
Q

What is a red flag symptom for urological malignancies?

A

Painless haematuria/persistent microscopic haematuria

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6
Q

What investigations should be done with a patient suspected with kidney cancer and is presenting with persistent non-visible haematuria?

A

1-3% have serious pathology

Flexible cystoscopy
US KUB

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7
Q

What does a CT urogram allow you to see?

A

Kidneys, ureter and a little bladder but doesn’t give full info

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8
Q

What does a flexible cystoscopy allow you to see?

A

Inside of bladder, ureter and prostate

Tumours of bladder lining (sea anenomes)
Red patches indicate pre-cancer/cancer in situ

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9
Q

If a patient is suspected with kidney cancer what investigations should you carry out?

A

CT renal triple phase
Staging CT chest
Bone scan is symptomatic

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10
Q

Explain the staging and grading of renal cell carcinoma?

A

TNM staging:
T1 - Tumour =< 7cm
T2 - Tumour > 7 cm
T3 - Extends outside kidney but not beyond adrenal or
perinephric fascia
T4 - Beyond perinephric fascia into surrounding
structures
N1 - Metastases in single regional lymph node
N2 - Metastases in 2 or more regional lymph node
M1 - Distant metastases

Fuhrman grade:
1 = well differentiated
2 = moderate differentiated
3+4 = poorly differentiated

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11
Q

What is the management for a patient with kidney cancer?

A

Depends on patient:
- Gold standard excision via partial/radical nephrectomy
- Cryosurgery (patients with small tumours unfit for
surgery)
- Receptor tyrosine kinase inhibitors (for metastases to
limit growth)
- Immunotherapy

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12
Q

When is a partial nephrectomy done over a radical nephrectomy?

A

If patient has:

  • Single kidney
  • Bilateral tumour
  • Multifocal RCC in patients with VHL
  • T1 tumours
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13
Q

What are the different types of bladder cancer and their percentage prevalences?

A

Transitional cell carcinoma - > 90%
Squamous cell carcinoma - 1-7%
Adenocarcinoma - 2%

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14
Q

What is the aetiology of bladder cancer?

A

Smoking
Radiation
Chronic catheterisation
Bliharzia/schistomiasis

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15
Q

What are the clinical features of bladder cancer?

A

Painless haematuria/persistent microscopic haematuria

Suprapubic pain
Lower urinary tract symptoms (associated UTI)
Metastatic disease symptoms - bone pain, limb swelling

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16
Q

What are some investigations that can be done for a patient suspected with bladder cancer and is presenting with painless visible haematuria?

A

Flexible cystoscopy
CT urogram
Renal function
Midstream specimen of urine (MSU) - infections

17
Q

What are some investigations that can be done for a patient suspected with bladder cancer and is presenting with persistent microscopic haematuria?

A

Flexible cystoscopy
US KUB
Midstream specimen of urine (MSU) - infections

18
Q

What do you do if a biopsy is taken of a patient with bladder cancer and its muscle invasive?

A

Proceed with staging investigations

19
Q

How is bladder cancer staged and graded?

A

TNM:
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 abdo wall
N1 - 1 lymph node below common iliac bifurcation
N2 - > 1 lymph node below common iliac bifurcation
M1 - Distant metastases

WHO classification:
G1 - well differentiated
G2 - moderate differentiated
G3 - poorly differentiated

20
Q

Why are cystoscopy and transurethral resection of bladder lesions done?

A

To obtain a biopsy for diagnostic histology or as a curative resection.

Heat is used to cut out visible bladder tumour

21
Q

What is the risk in cystoscopy and transurethral resection?

A

Go to deep and you perforate the bladder walls

Patient now needs laparoscopy

22
Q

What is the management for a patient with non muscle invasive bladder cancer?

A

If low grade and no CIS:

- cystoscopic surveillance +/- intravesicular chemotherapy/BCG

23
Q

What is BCG?

A

Immunotherapy which causes immune response in bladder

24
Q

What is the management for a patient with muscle invasive bladder cancer?

A

Cystectomy
Radiotherapy
+/- Chemotherapy
Palliative treatment

Depends on how fit the patient is

25
Q

What is the most common cancer in men in the UK?

A

Prostate cancer

26
Q

What types of cancer make up prostate cancers?

A

Adenocarcinoma > 95%

27
Q

What are the risk factors of prostate cancer?

A

Increasing age
Western nations
Ethnicity (black)

28
Q

What are the clinical features of prostate cancer?

A

Usually asymptomatic unless metastatic e.g. bone pain

Acute renal retention - hydronephrosis

29
Q

What investigations can you carry out for a patient suspected with prostate cancer?

A

Blood:
- PSA (prostate specific, not prostate-cancer specific)

MRI
Trans perineal prostate biopsy - systematic template biopsies of the prostate - no focal lesion just try and pick up lesions by probability of doing lots of biopsies

30
Q

Describe how prostate cancer is staged and graded

A 
TNM:
T1 - Non palpable/ visible on imaging
T2 - Palpable tumour
T3 - Beyond prostatic capsule into periprostatic fat
T4 - Tumour fixed onto adjacent structure/pelvic side wall
N1 - Regional lymph node
M1a - Non regional lymph node
M1B - Bone
M1x - Other sites

Gleason score: since multifocal, two scores based on level of differentiation
2-6 = well differentiated
7 = moderately differentiated
8 = poorly differentiated

31
Q

Explain the subdivisions of T1 staging

A

T1a - cancer < 5% of removed tissue
T1b - cancer >= 5% of removed tissue
T1c - cancer found by biopsy e.g. after raised PSA

32
Q

Explain the subdivisions of T2 staging in prostate cancer

A

T2a - cancer only in one half of one side of prostate
gland
T2b - cancer in more than half of one side of prostate but
not in both sides
T2c - cancer in both sides but still inside prostate gland

33
Q

Explain the subdivisions of T3 staging

A

T3a - cancer broken through prostatic capsule

T3b - cancer spread into seminal vesicles

34
Q

What is the management of prostate cancer?

A

If young/fit + high grade –> radical prostectomy/radiotherapy

If young and fit + low grade –> active surveillance

Post prostatectomy - monitor PSA. if > 0.2ng/ml then relapse (anti-androgen therapy, radiotherapy)

If old/unfit + high grade/metastatic –> anti-androgen therapy

If old/unfit + low grade–> regular PSA testing

35
Q

Why is anti-androgen/hormone therapy given to patients with prostate cancer?

A

Prostate size increases with testosterone and cancer seems to feed off it

36
Q

What side effects can prostatectomy have?

A

Removal of proximal urethral sphincter and changes urethral length

Risk of cavernous nerve damage causing erectile dysfunction

UROLOGY AND RENAL MEDICINE 2 (5 decks)

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