Urological Cancers Flashcards
What is the epidemiology of Kidney cancer?
13,100 new kidney cancer cases in the UK every year
Kidney cancer is the 7th most common cancer in the UK
Incidence and mortality rising
What types of cancer can kidney cancer be?
85% of kidney cancer is Renal Cell carcinoma(adenocarcinoma), 10% transitional cell carcinoma, Sarcoma/Wilms tumour/other types(5%)(2)
What are the risk factors for renal cancer?
Risk factors: Smoking, Renal failure and dialysis, obesity, hypertension
Genetic predisposition with Von Hippel-lindau syndrome (50% of individuals will develop RCC)
What are the clinical features of Kidney cancer?
Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
Additional Features of RCC include
Loin pain
Palpable mass
Metastatic disease symptoms –bone pain, haemoptysis
What are the investigations for Painlesss visible Haematuria?
Flexible cystoscopy
CT urogram
Renal function
What are the investigations for Persistent non-visible haematuria?
Flexible cystoscopy
US KUB
What are the investigations for suspected Kidney cancer?
CT renal triple phase
staging CT chest
bone scan if symptomatic
What is the TNM staging of Kidney cancer?
T1 – Tumour ≤ 7cm
T2 – Tumour >7cm
T3 – Extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia
T4 – Tumour beyond perinephric fascia into surrounding structures
N1 – Met in single regional LN
N2 – met in ≥2 regional LN
M1- distant met
What is T4 based on ?
Presence of Sarcomatoid/rhaboid differentiation
What is the criteria for Fuhrman grading?
1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated
What is the management for kidney cancer?
Patient specific ( depends on the ASA status, comorbidities, classification of lesion)
Gold standard is excision either via:
Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)
Radical Nephrectomy
What is the management for patients with small tumours unfit for surgery?
Cryosurgery
What is the management for metastatic disease?
Receptor tyrosine kinase inhibitors
What is the epidemiology for Bladder cancer?
10,200 new bladder cancer cases in the UK every year
Bladder cancer is the 11th most common cancer in the UK
Incidence and mortality declining
What are the main types of cancer in bladder cancer?
> 90% of bladder cancer is transitional cell carcinoma, 1-7% squamous cell carcinoma (75% SCC where schistosomiasis is endemic), Adenocarcinoma(2%)(2)
What are the risk factors for Bladder cancer?
Smoking, occupational exposure( aromatic hydrocarbons), chronic inflammation of bladder (bladder stones, schistosomiasis, long term catheter), drugs (cyclophosphamide), Radiotherapy