Urological Cancers

Question 1

Risk factors for prostate cancer

Answer 1

Increasing age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids

Question 2

Presentation of prostate cancer

Answer 2

Mostly asymptomatic

Lower UTI symptoms similar to BPH - Hesitancy, weak flow, frequency, terminal dribbling and nocturne

Haematuria
ED
Weight loss
Bone pain
Cauda equina syndrome

Question 3

Causes of raised PSA

Answer 3

Prostate cancer
BPH
Prostatitis
UTIs
Vigorous exercise
Recent ejaculation or prostate stimulation

Question 4

First line investigation for suspected prostate cancer

Answer 4

Multiparametric MRI using Likert scale.

1 – very low suspicion
2 – low suspicion
3 – equivocal
4 – probable cancer
5 – definite cancer

Question 5

How to establish diagnosis of prostate cancer?

Answer 5

Prostate biopsy

TRUS - transrectal ultrasound-guided biopsy
Transperineal biopsy

Question 6

Grading of prostate cancer

Answer 6

Gleason grading system - made up of two scores.

First score is the grade of the most prevalent pattern in the biopsy
Second score is the second most prevalent pattern in the biopsy

> 8 high risk
7 intermediate risk
6 is low risk

Question 7

Staging for prostate cancer

Answer 7

T (tumour), N (lymph nodes) and M (metastasis).

T for Tumour:

TX – unable to assess size
T1 – too small to be felt on examination or seen on scans
T2 – contained within the prostate
T3 – extends out of the prostate
T4 – spread to nearby organs

N for Nodes:

NX – unable to assess nodes
N0 – no nodal spread
N1 – spread to lymph nodes

M for Metastasis:

M0 – no metastasis
M1 – metastasis

Question 8

Management of prostate cancer

Answer 8

Surveillance
External beam radiotherapy
Brachytherapy
Hormone therapy - Androgen receptor blockers, GnRH agonists (goserelin), bilateral orchidectomy
Surgery - radical prostatectomy

Question 9

Testicular cancer types

Answer 9

Seminomas
Non-seminomas

Question 10

Risk factors for testicular cancer

Answer 10

Undescended testis
Male infertility
Family history
Increased height

Question 11

Presentation of testicular cancer

Answer 11

Painless lump

Non-tender
Hard
Irregular
Non-fluctuant
No translumination

Question 12

Investigations of testicular cancer

Answer 12

Scrotal USS
Tumour markers - AFP (raised in teratomas), Beta hCG (seminomas and non seminomas), LDH
Staging CT

Question 13

Staging of testicular cancer

Answer 13

Royal Marsden Staging System

Stage 1 – isolated to the testicle
Stage 2 – spread to the retroperitoneal lymph nodes
Stage 3 – spread to the lymph nodes above the diaphragm
Stage 4 – metastasised to other organs

Question 14

Management of testicular cancer

Answer 14

Surgery - radical orchidectomy
Chemo
Radio
Sperm banking for future use

Question 15

Long term side effects of testicular cancer treatment

Answer 15

Infertility
Hypogonadism
Peripheral neuropathy
Herring loss
Lasting kidney, liver and heart damage
Increased risk of cancer in the future

Question 16

Epithelia of bladder cancers

Answer 16

Transitional cell (90%)
Squamous cell

Question 17

Risk factors for bladder cancer

Answer 17

Smoking
Increasing age
Aromatic amines - used in dye and rubber industries
Schistosomiasis - causes squamous cell carcinoma

Question 18

Risk factors for bladder cancer

Answer 18

Smoking
Increasing age
Aromatic amines - used in dye and rubber industries
Schistosomiasis - causes squamous cell carcinoma

Question 19

Presentation of bladder cancer

Answer 19

Painless haematuria

Two week wait referral for:

Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI
Aged over 60 with microscopic haematuria (not visible but positive on a urine dipstick) PLUS:
Dysuria or;
Raised white blood cells on a full blood count

Question 20

Diagnosis of bladder cancer

Answer 20

Cystoscopy

Question 21

Treatment of bladder cancers

Answer 21

TURBT - for non-muscle-invasive bladder cancer

Intravesical chemo

Intravesical BCG - stimulates immune system to attack bladder tumour

Radical cystectomy with urostomy, continent urinary diversion, neobladder reconstruction or ureterosigmoidostomy

Chemo

Radio

Question 22

Most common type of kidney tumour

Answer 22

Renal cell carcinoma

Question 23

Classic presentation of renal cell carcinoma

Answer 23

Haematuria
Flank pain
Palpable mass

Question 24

Types of renal cell carcinoma

Answer 24

Clear cell
Papillary
Chromophobe
Wilm’s tumour (children)

Question 25

Risk factors for RCC

Answer 25

Smoking
Obesity
HTN
End-stage renal failure
Tuberous sclerosis

Question 26

Spread of RCC

Answer 26

Spreads to the tissues around the kidney within Gerota’s fascia and spreads to renal vein to IVC. Canon ball mets on chest x-ray

Question 27

RCC Paraneoplastic syndromes

Answer 27

Polycythaemia
Hypercalcaemia
HTN
Stauffer’s syndrome - abnormal liver function tests without liver mets