Urological cancers Flashcards
What is the most common type of kidney cancer?
Renal cell carcinoma (adenocarcinoma)
What is the name of the cancer where malignant cells form in the renl pelvis (top part of the kidney) and ureter?
Transitional cell carcinoma
What is a red flag symptom that can reflect any urological malignancy in the kidney, ureter, bladder or urethra?
Painless haematuria or Persistent microscopic haematuria (latter often in incidental scanning)
What is the most common presentation in kidney cancer patients?
Haematuria
What could you expect to find on physical examination of a kidney cancer patient?
Palpable mass
If you suspect kidney cancer, what should be done?
CT renal triple phase - assessment of renal masses
Staging CT Chest
Bone scan if symptomatic
What does the T1-4 mean in the TNM staging of RCC?
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
Define the N1-2 in the TNM staging of RCC?
N1 - Metastasis in single regional lymph node
N2 - Metastasis in ≥2 regional lymph nodes
What is meant by M1 in TNM staging of RCC?
Distant metastasis.
What grading system do you use for kidney cancer and describe what the different grades mean
FUHRMANS GRADE
1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated
What is the gold standard for kidney cancer management?
Partial nephrectomy
Radical nephrectomy - especially for RCC
When would you consider partial nephrectomy over a radical nephrectomy?
-Single kidney
-Bilateral tumour
-T1 tumours
In patients with small tumours unfit for surgery, what management is considered?
Cryosurgery
In metastatic disease, what management is considered?
Receptor Tyrsoine Kinase inhibitors
What is the most common type of bladder cancer?
90% of bladder cancer is Transitional Cell Carcinoma
Where shistosomiasis is endemic, what type of bladder cancer is most common?
Squamous cell carcinoma
What are additional features of bladder cancer?
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
If a patient has painless visible haematuria but you suspect anaemia, what test might you order?
FBC
What investigations would you carry out when there is painless visible haematuria?
-Flexible cytoscopy
-CT urogram
-Renal function
What investigations should be carried out for persistent microscopic haematuria?
Flexible cystoscopy
US Kidneys and Urinary Bladder - does not look at ureters in males, this is only seen in females
If biopsy is proven muscle invasive, then what investigation set should be done?
Staging investigations
What is the difference between Ta and Tis in TNM staging of bladder cancer?
Ta - non invasive papillary carcinoma
Tis - carcinoma in situ
What is the WHO classification grading system for bladder cancer?
G1 - Well differentiated
G2 - Moderate differentiated
G3 - Poorly differentiated
If the cancer is multifocal, what is treatment is recommended?
Bladder chemotherapy
What is MRI useful for in bladder cancers?
For fistula detection and investigation
What is a fistula?
A fistula is an abnormal connection or passageway that forms between two organs or between an organ and the skin.
When a patient acutely presents with haematuria, what investigation is performed?
Cystoscopy + Transuretheral resection of bladder lesion
Uses heat to cut out all visible bladder tumour
What is the management for non-muscle invasive bladder cancer?
If low grade and no carcinoma in situ:
-cystoscopic surveillance +/- intravesicular chemotherapy/Bacillus Calmette-Guerin (intravesicular immunotherapy that triggers immune response of bladder)
If the bladder cancer is muscle invasive, then what management should be carried out?
Cystectomy
Radiotherapy - but may not be fit enough
+/- chemotherapy as neo-adjuvant
Palliative treatment
What blood tests would you take whilst investigating prostate cancer?
PSA test (prostate specific antigen)
Why should you not screen for PSA in a patient with a UTI?
UTI can cause the prostate to enlarge which increases PSA
What investigation is superior to the previous gold standard of transrectal ultrasonography-guided prostate biopsies?
Multiparametric MRI before biopsy and then MRI targeted biopsy
What is the preferred way of taking a biopsy of the prostate?
Trans perineal prostate biopsy
What is meant by T1-4 in the TNM staging of 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
What is meant by T1a-T1c?
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
What does T2a-T2c mean?
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
What is meant by T3a-T3b?
T3a - cancer broken through capsule of prostate gland
T3b - cancer spread into seminal vesicles
What is meant by N1 in TNM staging of prostate cancer?
Regional lymph node involvement (pelvis)
What is meant by M1a, M1b and M1x in TNM staging of prostate cancer?
M1a- non regional LN (outside the pelvis)
M1b- bone
M1x- other sites
What do you use to report how differentiated a cancer cell is?
Gleason score.
If the patient is young and fit, then how does the management change if they have high or low grade cancer?
High grade (7 or +) → Radical prostatectomy/Radiotherapy
Low grade → Active surveillance (Regular PSA, MRI and Bx)
What are the side effects of the prostatectomy?
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)
