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Phase 1b - Urology & Renal Medicine > Urological Cancers > Flashcards

Urological Cancers Flashcards

1
Q

How many kidney cancer cases are diagnosed each year?

A
  • ~13,100 cases
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2
Q

What are the 3 types of renal cancers?

A
  • Renal cell carcinoma (adenocarcinoma) (85%)
  • Transitional cell carcinoma (10%)
  • Sarcoma / Wilm’s tumour (5%)
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3
Q

What is the most common form of renal cancer?

A
  • Renal cell carcinoma
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4
Q

What part of the kidney does renal cell carcinoma affect?

A
  • Renal malignancy arising from renal parenchyma / cortex accounting for 85% of kidney cancers
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5
Q

What are the main risk factors for renal cancer (6)?

A
  • Smoking
  • Renal failure
  • Dialysis
  • Obesity
  • Hypertension
  • Von Hippel-Lindau syndrome
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6
Q

What are the clinical features of renal cancer (5)?

A
  • Painless haematuria
  • Persistent microscopic haematuria
  • Additional Features:
    • Loin pain
    • Palpable mass
    • Metastatic disease symptom:
      • Bone pain
      • Haempopytis
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7
Q

What is a red flag in kidney cancer?

A
  • Persistent microscopic haematuria - reflecting urological malignancies
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8
Q

What initial investigations are conducted in patients with suspected renal cancer with visible haematuria (3)?

A
  • Flexible cystoscopy
  • CT urogram (Kidneys, ureter & urinary bladder)
  • Check renal function
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9
Q

What initial investigations are conducted in patients with suspected renal cancer with non-visible haematuria (2)?

A
  • Flexible cystoscopy
  • US KUB (Kidneys, ureter & urinary bladder)
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10
Q

What is a flexible cystoscopy?

A
  • A flexible cystoscopy through the urethra & bladder
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11
Q

What investigations are conducted in patients with suspected renal cancer (3)?

A
  • 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
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12
Q

What staging and grading system is used to assess the progress of renal cancer?

A
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13
Q

What is the gold standard treatment for RCC?

Patient specific (depends on the ASA status, comorbidities, classification of lesion)

A
  • Excision: Partial nephrectomy
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14
Q

What is a partial nephrectomy? What is the condition for a partial nephrectomy?

A
  • A partial nephrectomy involves the excision of the lesion without comprising the entire organ, given that kidney function is impaired
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15
Q

What is a radical nephrectomy?

A
  • The resection of the entire kidney
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16
Q

What option is available for patients with small kidney tumours and unfit for surgery?

A
  • Cryosurgery
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17
Q

What drug treatment is available for patients with metastatic disease?

A
  • Receptor tyrosine kinase inhibitors
    • Targeted chemotherapy
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18
Q

What are the 3 types of bladder cancer?

A
  • Transitional cell carcinoma (TCC) (>90%)
  • Squamous cell carcinoma (SCC) (1-7%)
  • Adenocarcinoma (2%)
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19
Q

What is the most common form of bladder cancer?

A
  • Transitional cell carcinoma
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20
Q

Why is squamous cell carcinomas of the bladder common in Egypt?

A
  • Schistosomiasis is endemic

75% of bladder cancer is SCC where schistosomiasis is endemic

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21
Q

What type of variants of bladder cancer is common?

A
  • Non-muscle invasive tumours
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22
Q

How are high grade tumours of the bladder shown?

A
  • Flat or in-situ, there are difficult to visualise
23
Q

What are the risk factors for bladder cancer (6)?

A
  • Smoking (Tobacco) exposure
  • Male gender
  • Age > 55 years
  • Exposure to chemical carcinogens
  • Pelvic radiation
  • Systemic chemotherapy
24
Q

What are the clinical features of bladder cancer (5)?

A
  • 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
25
Q

What initial investigations are conducted in patients with suspected bladder cancer with visible haematuria (3)?

A
  • Flexible cystoscopy
  • CT urogram (Kidneys, ureter & urinary bladder)
  • Check renal function
26
Q

What initial investigations are conducted in patients with suspected bladder cancer with non-visible haematuria (2)?

A
  • Flexible cystoscopy
  • US KUB (Kidneys, ureter & urinary bladder)
27
Q

What staging and grading system is used to assess the progress of bladder cancer?

A
28
Q

How is a non-muscle invasive tumour treated?

A
  • Low grade - and no CIS then consideration of cystoscopic surveillance
  • intravesicular chemotherapy / BCG vaccine
29
Q

How can a BCG vaccine treat bladder tumours?

A
  • Elicits inflammatory response to reduce the risk of the progression of bladder lesion cancer
30
Q

What options are available for a patient with a muscle invasive bladder tumour (3)?

A
  • Cystectomy
  • Radiotherapy +/- chemotherapy
  • Palliative treatment
    • In situ red patches in the bladder are a poor prognostic factor
31
Q

What treatment is conducted in a patient with an initial tumour of the bladder?

A
  • Cystoscopy + transurethral resection of the bladder - using heat to ablate the visible tumour
    • Provides histology and is curative
32
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma

> 95% of prostate cancer

33
Q

What are the risk factors of prostate cancer (3)?

A
  • Increasing age
  • Western nations (Scandinavian countries)
  • Ethnicity (African Americans)
34
Q

What are the clinical features of prostatic cancer?

A
  • Usually asymptomatic unless metastatic
35
Q

What marker is elevated in patients with prostate cancer?

A
  • PSA - prostate specific antigen
36
Q

Under what circumstances is PSA elevated?

A
  • Elevated in UTI and prostatitis
37
Q

What is the recommended imaging investigation for prostate cancer?

A
  • MRI prior to biopsy testing
38
Q

What staging and grading system is used to assess the progress of prostate cancer?

A
39
Q

What treatment is available for a patient with a low grade cancer?

A
  • Active surveillance (regular PSA, MRI and Bx)
40
Q

What treatment is available for a patient who is unfit and has a high grade cancer?

A
  • Hormone therapy
41
Q

What treatment is available for young and fit patients with a high grade cancer?

A
  • Radical prostatectomy
42
Q

What risk are associated with a prostatectomy (4)?

A
  • 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
  • Urethral length changes during operation
    • Affects continence
  • Erectile dysfunction
43
Q

What is the main treatment for incontinence induced by a prostatectomy (2)?

A
  • Pelvic floor muscle exercises
    • Artificial urinary sphincter device if exercises fail
44
Q

What treatment is available for a patient with erectile dysfunction?

A
  • Viagra, or prostaglandin E1 and if insufficient - penile prosthesis
45
Q

What follow up investigations are conducted to monitor a post-prosatectomy?

A
  • Monitor PSA (should be undetectable)
46
Q

What PSA level indicates a prostate cancer relapse post-prostatectomy?

A
  • > 0.2 ng/ml
47
Q

A Fuhrman grade 1 for RCC suggests what?

A
  • Well differentiated
48
Q

A Fuhrman grade 2 for RCC suggests what?

A
  • Moderate differentiation
49
Q

A Fuhrman grade 3+4 suggests what?

A
  • Poorly differentiated (4= presence of sarcomatoid / rhomboid differentiation)
50
Q

What does Ta suggest for bladder cancer staging?

A
  • Non-invasive papillary carcinoma
51
Q

What does Tis suggest for bladder cancer staging?

A
  • Carcinoma in situ
52
Q

What does T1 suggest in a patient with bladder cancer?

A
  • Invades sub-epithelial connective tissue
53
Q

A T2 bladder cancer stage suggests what?

A
  • Invades muscularis propria
54
Q

What does a 4+3 prostatic tumour suggest?

A
  • More likely to grow bilaterally and spread

Phase 1b - Urology & Renal Medicine (11 decks)

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