UROLOGICAL CANCERS Flashcards
What types of cancers make up kidney cancer and what are their percentage prevalences?
Renal cell carcinoma (adenocarcinoma) - 85%
Transitional cell carcinoma - 10%
Others - 5%
What is the aetiology behind kidney cancers?
Smoking Obesity Kidney dialysis Hypertension Genetics
What are the clinical features of kidney cancer?
Haematuria - main symptom
Loin pain
Palpable mass
Metastatic disease symptoms e.g. bone pain, SOB, Haemoptysis
What investigations should be done with a patient suspected with kidney cancer and is presenting with painless visible haematuria?
50-60% have serious pathology
Flexible cystoscopy
CT urogram
Renal function test
What is a red flag symptom for urological malignancies?
Painless haematuria/persistent microscopic haematuria
What investigations should be done with a patient suspected with kidney cancer and is presenting with persistent non-visible haematuria?
1-3% have serious pathology
Flexible cystoscopy
US KUB
What does a CT urogram allow you to see?
Kidneys, ureter and a little bladder but doesn’t give full info
What does a flexible cystoscopy allow you to see?
Inside of bladder, ureter and prostate
Tumours of bladder lining (sea anenomes)
Red patches indicate pre-cancer/cancer in situ
If a patient is suspected with kidney cancer what investigations should you carry out?
CT renal triple phase
Staging CT chest
Bone scan is symptomatic
Explain the staging and grading of renal cell carcinoma?
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
What is the management for a patient with kidney cancer?
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
When is a partial nephrectomy done over a radical nephrectomy?
If patient has:
- Single kidney
- Bilateral tumour
- Multifocal RCC in patients with VHL
- T1 tumours
What are the different types of bladder cancer and their percentage prevalences?
Transitional cell carcinoma - > 90%
Squamous cell carcinoma - 1-7%
Adenocarcinoma - 2%
What is the aetiology of bladder cancer?
Smoking
Radiation
Chronic catheterisation
Bliharzia/schistomiasis
What are the clinical features of bladder cancer?
Painless haematuria/persistent microscopic haematuria
Suprapubic pain
Lower urinary tract symptoms (associated UTI)
Metastatic disease symptoms - bone pain, limb swelling
What are some investigations that can be done for a patient suspected with bladder cancer and is presenting with painless visible haematuria?
Flexible cystoscopy
CT urogram
Renal function
Midstream specimen of urine (MSU) - infections
What are some investigations that can be done for a patient suspected with bladder cancer and is presenting with persistent microscopic haematuria?
Flexible cystoscopy
US KUB
Midstream specimen of urine (MSU) - infections
What do you do if a biopsy is taken of a patient with bladder cancer and its muscle invasive?
Proceed with staging investigations
How is bladder cancer staged and graded?
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
Why are cystoscopy and transurethral resection of bladder lesions done?
To obtain a biopsy for diagnostic histology or as a curative resection.
Heat is used to cut out visible bladder tumour
What is the risk in cystoscopy and transurethral resection?
Go to deep and you perforate the bladder walls
Patient now needs laparoscopy
What is the management for a patient with non muscle invasive bladder cancer?
If low grade and no CIS:
- cystoscopic surveillance +/- intravesicular chemotherapy/BCG
What is BCG?
Immunotherapy which causes immune response in bladder
What is the management for a patient with muscle invasive bladder cancer?
Cystectomy
Radiotherapy
+/- Chemotherapy
Palliative treatment
Depends on how fit the patient is
What is the most common cancer in men in the UK?
Prostate cancer
What types of cancer make up prostate cancers?
Adenocarcinoma > 95%
What are the risk factors of prostate cancer?
Increasing age
Western nations
Ethnicity (black)
What are the clinical features of prostate cancer?
Usually asymptomatic unless metastatic e.g. bone pain
Acute renal retention - hydronephrosis
What investigations can you carry out for a patient suspected with prostate cancer?
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
Describe how prostate cancer is staged and graded
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
Explain the subdivisions of T1 staging
T1a - cancer < 5% of removed tissue
T1b - cancer >= 5% of removed tissue
T1c - cancer found by biopsy e.g. after raised PSA
Explain the subdivisions of T2 staging in prostate cancer
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
Explain the subdivisions of T3 staging
T3a - cancer broken through prostatic capsule
T3b - cancer spread into seminal vesicles
What is the management of prostate cancer?
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
Why is anti-androgen/hormone therapy given to patients with prostate cancer?
Prostate size increases with testosterone and cancer seems to feed off it
What side effects can prostatectomy have?
Removal of proximal urethral sphincter and changes urethral length
Risk of cavernous nerve damage causing erectile dysfunction
