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Urology and renal medicine > Urological cancers > Flashcards

Urological cancers Flashcards

1
Q

What is the most common type of kidney cancer?

A

Renal cell carcinoma (adenocarcinoma)

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2
Q

What is the name of the cancer where malignant cells form in the renl pelvis (top part of the kidney) and ureter?

A

Transitional cell carcinoma

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3
Q

What is a red flag symptom that can reflect any urological malignancy in the kidney, ureter, bladder or urethra?

A

Painless haematuria or Persistent microscopic haematuria (latter often in incidental scanning)

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4
Q

What is the most common presentation in kidney cancer patients?

A

Haematuria

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5
Q

What could you expect to find on physical examination of a kidney cancer patient?

A

Palpable mass

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6
Q

If you suspect kidney cancer, what should be done?

A

CT renal triple phase - assessment of renal masses

Staging CT Chest

Bone scan if symptomatic

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7
Q

What does the T1-4 mean in the TNM staging of RCC?

A

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

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8
Q

Define the N1-2 in the TNM staging of RCC?

A

N1 - Metastasis in single regional lymph node

N2 - Metastasis in ≥2 regional lymph nodes

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9
Q

What is meant by M1 in TNM staging of RCC?

A

Distant metastasis.

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10
Q

What grading system do you use for kidney cancer and describe what the different grades mean

A

FUHRMANS GRADE
1 = well differentiated

2 = moderate differentiated

3 + 4 = poorly differentiated

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11
Q

What is the gold standard for kidney cancer management?

A

Partial nephrectomy

Radical nephrectomy - especially for RCC

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12
Q

When would you consider partial nephrectomy over a radical nephrectomy?

A

-Single kidney
-Bilateral tumour
-T1 tumours

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13
Q

In patients with small tumours unfit for surgery, what management is considered?

A

Cryosurgery

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14
Q

In metastatic disease, what management is considered?

A

Receptor Tyrsoine Kinase inhibitors

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15
Q

What is the most common type of bladder cancer?

A

90% of bladder cancer is Transitional Cell Carcinoma

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16
Q

Where shistosomiasis is endemic, what type of bladder cancer is most common?

A

Squamous cell carcinoma

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17
Q

What are additional features of bladder cancer?

A

Suprapubic pain

Lower urinary tract symptoms - burning pee, bloody urine etc

Metastatic disease symptoms - bone pain, lower limb swelling

Irritative - going to the toilet a lot

18
Q

If a patient has painless visible haematuria but you suspect anaemia, what test might you order?

A

FBC

19
Q

What investigations would you carry out when there is painless visible haematuria?

A

-Flexible cytoscopy
-CT urogram
-Renal function

20
Q

What investigations should be carried out for persistent microscopic haematuria?

A

Flexible cystoscopy

US Kidneys and Urinary Bladder - does not look at ureters in males, this is only seen in females

21
Q

If biopsy is proven muscle invasive, then what investigation set should be done?

A

Staging investigations

22
Q

What is the difference between Ta and Tis in TNM staging of bladder cancer?

A

Ta - non invasive papillary carcinoma

Tis - carcinoma in situ

23
Q

What is the WHO classification grading system for bladder cancer?

A

G1 - Well differentiated

G2 - Moderate differentiated

G3 - Poorly differentiated

24
Q

If the cancer is multifocal, what is treatment is recommended?

A

Bladder chemotherapy

25
Q

What is MRI useful for in bladder cancers?

A

For fistula detection and investigation

26
Q

What is a fistula?

A

A fistula is an abnormal connection or passageway that forms between two organs or between an organ and the skin.

27
Q

When a patient acutely presents with haematuria, what investigation is performed?

A

Cystoscopy + Transuretheral resection of bladder lesion

Uses heat to cut out all visible bladder tumour

28
Q

What is the management for non-muscle invasive bladder cancer?

A

If low grade and no carcinoma in situ:

-cystoscopic surveillance +/- intravesicular chemotherapy/Bacillus Calmette-Guerin (intravesicular immunotherapy that triggers immune response of bladder)

29
Q

If the bladder cancer is muscle invasive, then what management should be carried out?

A

Cystectomy

Radiotherapy - but may not be fit enough

+/- chemotherapy as neo-adjuvant

Palliative treatment

30
Q

What blood tests would you take whilst investigating prostate cancer?

A

PSA test (prostate specific antigen)

31
Q

Why should you not screen for PSA in a patient with a UTI?

A

UTI can cause the prostate to enlarge which increases PSA

32
Q

What investigation is superior to the previous gold standard of transrectal ultrasonography-guided prostate biopsies?

A

Multiparametric MRI before biopsy and then MRI targeted biopsy

33
Q

What is the preferred way of taking a biopsy of the prostate?

A

Trans perineal prostate biopsy

34
Q

What is meant by T1-4 in the TNM staging of prostate cancer?

A

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

35
Q

What is meant by T1a-T1c?

A

T1a means cancer is <5% of removed tissue

T1b means cancer is ≥5% of removed tissue

T1c cancers are found by biopsy, for example after raised PSA level

36
Q

What does T2a-T2c mean?

A

T2a - cancer only half on one side of prostate gland

T2b - cancer in more than half a side of prostate gland but not on both sides

T2c - cancer in both sides but still inside prostate gland

37
Q

What is meant by T3a-T3b?

A

T3a - cancer broken through capsule of prostate gland

T3b - cancer spread into seminal vesicles

38
Q

What is meant by N1 in TNM staging of prostate cancer?

A

Regional lymph node involvement (pelvis)

39
Q

What is meant by M1a, M1b and M1x in TNM staging of prostate cancer?

A

M1a- non regional LN (outside the pelvis)

M1b- bone

M1x- other sites

40
Q

What do you use to report how differentiated a cancer cell is?

A

Gleason score.

41
Q

If the patient is young and fit, then how does the management change if they have high or low grade cancer?

A

High grade (7 or +) → Radical prostatectomy/Radiotherapy

Low grade → Active surveillance (Regular PSA, MRI and Bx)

42
Q

What are the side effects of the prostatectomy?

A

Incontinence - due to removal of proximal sphincter and so there is increased urethral length

Erectile Dysfunction - damage to cavernous nerves (innervation to bladder and urethra)

Urology and renal medicine (5 decks)

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