Urological Cancers Flashcards
How many kidney cancer cases are diagnosed each year?
- ~13,100 cases
What are the 3 types of renal cancers?
- Renal cell carcinoma (adenocarcinoma) (85%)
- Transitional cell carcinoma (10%)
- Sarcoma / Wilm’s tumour (5%)
What is the most common form of renal cancer?
- Renal cell carcinoma
What part of the kidney does renal cell carcinoma affect?
- Renal malignancy arising from renal parenchyma / cortex accounting for 85% of kidney cancers
What are the main risk factors for renal cancer (6)?
- Smoking
- Renal failure
- Dialysis
- Obesity
- Hypertension
- Von Hippel-Lindau syndrome
What are the clinical features of renal cancer (5)?
- Painless haematuria
- Persistent microscopic haematuria
- Additional Features:
- Loin pain
- Palpable mass
-
Metastatic disease symptom:
- Bone pain
- Haempopytis
What is a red flag in kidney cancer?
- Persistent microscopic haematuria - reflecting urological malignancies
What initial investigations are conducted in patients with suspected renal cancer with visible haematuria (3)?
- Flexible cystoscopy
- CT urogram (Kidneys, ureter & urinary bladder)
- Check renal function
What initial investigations are conducted in patients with suspected renal cancer with non-visible haematuria (2)?
- Flexible cystoscopy
- US KUB (Kidneys, ureter & urinary bladder)
What is a flexible cystoscopy?
- A flexible cystoscopy through the urethra & bladder
What investigations are conducted in patients with suspected renal cancer (3)?
- CT renal triple phase scan - a delayed scan with contrast for improved characterisation of a lesion
- Staging CT chest
- Bone scan if symptomatic - identify any bony mets
What staging and grading system is used to assess the progress of renal cancer?
What is the gold standard treatment for RCC?
Patient specific (depends on the ASA status, comorbidities, classification of lesion)
- Excision: Partial nephrectomy
What is a partial nephrectomy? What is the condition for a partial nephrectomy?
- A partial nephrectomy involves the excision of the lesion without comprising the entire organ, given that kidney function is impaired
What is a radical nephrectomy?
- The resection of the entire kidney
What option is available for patients with small kidney tumours and unfit for surgery?
- Cryosurgery
What drug treatment is available for patients with metastatic disease?
-
Receptor tyrosine kinase inhibitors
- Targeted chemotherapy
What are the 3 types of bladder cancer?
- Transitional cell carcinoma (TCC) (>90%)
- Squamous cell carcinoma (SCC) (1-7%)
- Adenocarcinoma (2%)
What is the most common form of bladder cancer?
- Transitional cell carcinoma
Why is squamous cell carcinomas of the bladder common in Egypt?
- Schistosomiasis is endemic
75% of bladder cancer is SCC where schistosomiasis is endemic
What type of variants of bladder cancer is common?
- Non-muscle invasive tumours
How are high grade tumours of the bladder shown?
- Flat or in-situ, there are difficult to visualise
What are the risk factors for bladder cancer (6)?
- Smoking (Tobacco) exposure
- Male gender
- Age > 55 years
- Exposure to chemical carcinogens
- Pelvic radiation
- Systemic chemotherapy
What are the clinical features of bladder cancer (5)?
- Painless haemturia
-
Persistent microscopic haemturia
- Red flag (microscopic haematuria is detected using a urine dipstick)
- Suprapubic pain
- Lower UTI symptoms - increased frequency of urination
-
Metastatic disease symptoms
- Bone pain
- Lower limb swelling
- Compressional lymph nodes
What initial investigations are conducted in patients with suspected bladder cancer with visible haematuria (3)?
- Flexible cystoscopy
- CT urogram (Kidneys, ureter & urinary bladder)
- Check renal function
What initial investigations are conducted in patients with suspected bladder cancer with non-visible haematuria (2)?
- Flexible cystoscopy
- US KUB (Kidneys, ureter & urinary bladder)
What staging and grading system is used to assess the progress of bladder cancer?
How is a non-muscle invasive tumour treated?
- Low grade - and no CIS then consideration of cystoscopic surveillance
- intravesicular chemotherapy / BCG vaccine
How can a BCG vaccine treat bladder tumours?
- Elicits inflammatory response to reduce the risk of the progression of bladder lesion cancer
What options are available for a patient with a muscle invasive bladder tumour (3)?
- Cystectomy
- Radiotherapy +/- chemotherapy
-
Palliative treatment
- In situ red patches in the bladder are a poor prognostic factor
What treatment is conducted in a patient with an initial tumour of the bladder?
- Cystoscopy + transurethral resection of the bladder - using heat to ablate the visible tumour
- Provides histology and is curative
What is the most common type of prostate cancer?
Adenocarcinoma
> 95% of prostate cancer
What are the risk factors of prostate cancer (3)?
- Increasing age
- Western nations (Scandinavian countries)
- Ethnicity (African Americans)
What are the clinical features of prostatic cancer?
- Usually asymptomatic unless metastatic
What marker is elevated in patients with prostate cancer?
- PSA - prostate specific antigen
Under what circumstances is PSA elevated?
- Elevated in UTI and prostatitis
What is the recommended imaging investigation for prostate cancer?
- MRI prior to biopsy testing
What staging and grading system is used to assess the progress of prostate cancer?
What treatment is available for a patient with a low grade cancer?
- Active surveillance (regular PSA, MRI and Bx)
What treatment is available for a patient who is unfit and has a high grade cancer?
- Hormone therapy
What treatment is available for young and fit patients with a high grade cancer?
- Radical prostatectomy
What risk are associated with a prostatectomy (4)?
- The prostate contains the proximal sphincteric unit
- Controls degree of urinary continence
- Aprostatectomy removes the proximal urethral sphincter
- Inadvertent damage to the cavernous nerve to the prostate (neural innervation to the bladder and urethra)
- Bladder function is affected
- Inadvertent damage to the cavernous nerve to the prostate (neural innervation to the bladder and urethra)
- Urethral length changes during operation
- Affects continence
- Erectile dysfunction
What is the main treatment for incontinence induced by a prostatectomy (2)?
-
Pelvic floor muscle exercises
- Artificial urinary sphincter device if exercises fail
What treatment is available for a patient with erectile dysfunction?
- Viagra, or prostaglandin E1 and if insufficient - penile prosthesis
What follow up investigations are conducted to monitor a post-prosatectomy?
- Monitor PSA (should be undetectable)
What PSA level indicates a prostate cancer relapse post-prostatectomy?
- > 0.2 ng/ml
A Fuhrman grade 1 for RCC suggests what?
- Well differentiated
A Fuhrman grade 2 for RCC suggests what?
- Moderate differentiation
A Fuhrman grade 3+4 suggests what?
- Poorly differentiated (4= presence of sarcomatoid / rhomboid differentiation)
What does Ta suggest for bladder cancer staging?
- Non-invasive papillary carcinoma
What does Tis suggest for bladder cancer staging?
- Carcinoma in situ
What does T1 suggest in a patient with bladder cancer?
- Invades sub-epithelial connective tissue
A T2 bladder cancer stage suggests what?
- Invades muscularis propria
What does a 4+3 prostatic tumour suggest?
- More likely to grow bilaterally and spread
