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
What are the clinical features of Bladder cancer?
Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
Additional Features of bladder cancer include
Suprapubic pain
Lower urinary tract symptoms and UTI
Metastatic disease symptoms –bone pain, lower limb swelling
What should you do if biopsy proves muscle invasive?
Staging investigations
What is the TNM staging for bladder cancer?
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 abdominal wall
N1 – 1 LN below common iliac birufication
N2 - >1 LN below common iliac birufication
N3 – Mets in a common iliac LN
M1- distant mets
What is the WHO classification for bladder cancer?
G1 = well differentiated G2 = moderate differentiated G3 = poorly differentiated
How can Cytoscopy be used to treat bladder cancer?
A transurethral resection of bladder lesion uses heat to cut out all visible bladder tumour.
This provides histology and also can be curative.
What happens if the tumour extends beyond muscle?
the resection is incomplete due to the risk of perforating the bladder
What is Non muscle invasive management for bladder cancer?
- If low grade and no CIS then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG
What is Muscle Invasive management for bladder cancer?
Cystectomy
Radiotherapy
+/- chemotherapy
Palliative treatment
What is the epidemiology of Prostate cancer?
48,500 new prostate cancer cases in the UK every year (4)
Prostate cancer is the most common cancer in men within the UK(4)
Incidence rising but mortality rates declining (4
What type of cancer is Prostate cancer?
> 95% of prostate cancer is adenocarcinoma (2)
What are the risk factors for Prostate cancer?
: Increasing age, Western nations(Scandinavian countries), Ethnicity(African Americans)
What are the clinical features of prostate cancer?
Usually asymptomatic unless metastatic
What blood tests can be done for Prostate cancer?
PSA is prostate-specific but not prostate-cancer specific Can be elevated in (UTI, prostatitis,Benign prostatic hyperplasia)
What investigations are done for prostate cancer?
imaging prior to biopsy testing
multiparametric MRI before biopsy and MRI targeted biopsy is superior to the previous gold standard of transrectal ultrasonography-guided prostate biopsies
What are trans perineal prostate biopsies?
Systematic template biopsies of the prostate
Widely used in most centres over transrectal biopsies as less risk of infection and able to sample all areas of the prostate
What is the TNM staging for Prostate cancer?
T1 – non palpable or visible on imaging T2 – palpable tumour T3 – beyond prostatic capsule into periprostatic fat T4 – tumour fixed onto adjacent structure/pelvic side wall N1 – regional LN (pelvis) M1a- non regional LN M1b- bone M1x- other sites
What is the Gleeson score for prostate cancer?
Since multifocal two scores based on level of differentiation
2-6 = Well differentiated
7 = Moderately differentiated
8 – Poorly differentiated
What does T1 mean (prostate)?
Too small to be seen on a scan, , or felt during prostate examination.
T1a - less than 5% of the removed tissue (commonly found in surgery for other reasons)
T1b - 5% or more of removed tissue, also found in surgery
T1c - cancers found by biopsy, e.g. after a raised PSA
What does T2 mean (prostate)?
cancer is completely inside the prostate gland
T2a - cancer is only half on one side of the prostate gland
T2b - cancer is more than half of one side of the prostate gland but not both sides
T2c - cancer is on both sides but inside the prostate gland
What does T3 mean (prostate)?
cancer has broken through the capsule covering the prostate gland
T3a - cancer has broken through the capsule covering the prostate gland
T3b - cancer has spread into the tubes that carry semen
What does T4 mean?
Cancer has spread into other body organs nearby, such as the back passage, bladder/pelvic wall
What is the management for prostate cancer?
Highly dependent on patient age/comorbidities and stage and grade of prostate cancer
If young and fit + High grade cancer Radical prostatectomy/Radiotherapy
+ Low grade cancer Active surveillance ( Regular PSA, MRI and Bx)
Post prostatectomy – monitor PSA ( should be undetectable or <0.01ng/ml). If >0.2ng/ml then relapse
If old/unfit + high grade cancer/Metastatic disease Hormone therapy
+ Low grade cancer Watchful waiting (regular PSA testing)
What should PSA be post surgery?
PSA should be undetectable or <0.01 ng/ml. Patients should undergo PSA testing 6 monthly and a biochemical relapse is defined as a PSA >0.2ng/ml.
What are the risks associated with Prostate management?
The prostate contains the proximal sphincter
Prostatectomy removes the proximal urethral sphincter and changes urethral length.
Risk of damage to cavernous nerves ( innervation to bladder and urethra)(7)
Damage to cavernous nerves causes ED.
