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Aneesha Flashcards BRS 2 > Urological cancers > Flashcards

Urological cancers Flashcards

1
Q

How common I kidney cancer?
Incidence/ mortality trend?

A
  • Kidney cancer is 7th most common cancer in UK
  • Incidence and mortality rising
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2
Q

What types of kidney cancers are there and which is the most common?

A

Most are renal cell carcinomas (adenocarcinomas)
Transitional cell carcinomas
Sarcomas/Wilms tumor/ other types

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3
Q

What aetiological factors are there that cause kidney cancers?

A

Smoking
Hypertension
Renal failure and dialysis
Genetic predisposition with Von Hippel-Lindau syndrome (50% of individuals will develop RCC)

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4
Q

What clinical features can you find in kidney cancers?

A

-You may or may not feel a mass- if there is a mass there’s likely to be systemic symptoms too like weight loss or anaemic or polycythaemic (because of paraneoplastic syndromes), hypercalcaemia (again since tumour might secrete this)
- Loin pain
- Haemorrhage
-Varicocele
- Metastatic disease symptoms like bone pain, haemoptysis, shortness of breath
- Commonest- painless haematuria (particularly if large tumour like transitional cell carcinoma) or persistent microscopic haematuria- a red flag and can reflect urological malignancies

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5
Q

If you can’t find a mass how then do we often find kidney cancers?

A

A lot of them are incidentally found on scans

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6
Q

Where and why would you see varicocele in kidney cancer?

A
  • left sided renal tumours
  • You get compression of renal vein due to tumour thrombus
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7
Q

What investigations would we do on painless visible haematuria?

A

Ask a history about smoking, coagulation problems
CT urogram
Flexible cystoscopy
Renal function

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8
Q

What is CT urogram used for?

A
  • The top end of the urinary system- CT scan of kidneys which could reveal masses
  • Can look down ureters too to look for pathology there e.g. ureteric filling defect which could indicate transitional cell carcinomas or stones (which also cause haematuria)
  • Get a little idea of the bladder but we don’t look at it directly- if we see a large bladder mass causing haematuria we might see a filling defect or clot in the bladder
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9
Q

What is flexible cystoscopy and what is it used to look for

A
  • Looking at bladder under local anaesthetic- looking for exophytic lesions (looking for tumours) or bleeding from ureteric orifices which could mean bleed is higher (e.g. ureters) and its trickling down into bladder
  • Can look at urethra for transitional cell carcinoma
  • Can see strictures that cause haematuria or bleeding prostate
  • Red patches in bladder could indicate pre-cancer or carcinoma in-situ
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10
Q

What investigations do we do on persistent non visible haematuria?

A
  • Flexible cystoscopy
  • US KUB (US of kidneys, ureter and bladder)
    -((CT urogram))
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11
Q

What is non-visible haematuria?

A

When you see RBCs in urine on microscopy or dipstick but not visually

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12
Q

Which out of visible and non-visible haematuria are we more concerned about?
How would they present in clinic?
Other than bladder cancer what could this indicate?

A
  • Visible because usually these cases have serious underlying pathology
    • Often see them in clinic with large bladder and anaemic and have to wash out bladder because of clots
  • Also have to check for visible haematuria to see if there’s a renal problem, esp if there’s proteinuria
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13
Q

How do we investigate a suspected renal cancer?

A
  • CT renal triple phase
  • Staging CT chest
  • Bone scan if symptomatic
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14
Q

What staging system would we use for RCC?

A

TNM staging (see pic)

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15
Q

What grading system can we use for kidney cancer?

A

Fuhrman grade

  • 1 = well differentiated
  • 2 = moderately differentiated
  • 3 + 4 = poorly differentiated
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16
Q

What is kidney cancer management dependent on?

A

Patient specific- depends on:

  • ASA status (healthiness of patient)
  • Comorbidities
  • Classification of lesion
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17
Q

How do we manage kidney cancer in patients with small tumours who are unfit for surgery?

A
  • Cryosurgery- freeze the lesion
  • Can follow it up with serial scanning
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18
Q

What is the gold standard for management of kidney cancer?

A

Excision either via partial nephrectomy or radical nephrectomy (full kidney removal)

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19
Q

When would we do a partial nephrectomy?

A
  • single kidney
  • bilateral tumour
  • multifocal RCC in patients with VHL (multiple small lesions)
  • T1 tumours (up to 7cm)
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20
Q

How would we treat metastatic kidney disease?

A
  • Receptor tyrosine kinase inhibitors
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21
Q

What do we want to avoid in resection of kidney cancer?

A

Taking out so much kidney that we have to put them on dialysis

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22
Q

Why is incidence and mortality of bladder cancer declining?

A
  • more screening
  • less patients are smoking
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23
Q

What types of bladder cancers are there?

A

> 90% are transitional cell carcinoma
squamous cell carcinoma
adenocarcinoma

24
Q

complication of transitional cell carcinoma of the bladder?

A
  • TCC arises from transitional epithelium which also lines ureter and kidney
  • If you have a bladder cancer you could get a field change where the cancer travels all the way up from urethra to kidney
    (therefore these patient need a CT scan to assess urothelium everywhere else)
25
Q

Commonest cause of squamous cell carcinoma of the bladder?

A

schistosomiasis- an infection caused by blood flukes (parasites)

26
Q

Aetiological causes of bladder cancer

A
  • Smoking
  • occupational exposure (aromatic hydrocarbons)
  • chronic inflammation of bladder (bladder stones, schistosomiasis, long term catheter)
  • drugs (cyclophosphamide)
  • radiotherapy
27
Q

How might bladder cancer patients present?

A
  • Visible/non-visible haematuria
    • Retention of urine
    • Clots
    • Ureteric bleeding
  • Lower urinary tract symptoms e.g. irritation (always wanting to go to the toilet)
  • UTI e.g. in older patients, esp if they’re smokers, who have UTI you might want to think about bladder cancer
  • Suprapubic pain
  • Metastatic disease symptoms e.g. bone pain, lower limb swelling
28
Q

How can renal function be impaired due to transitional cell carcinoma of the bladder

A

If you have a TCC in ureter or renal pelvis then it may cause ureteric dilatation due to causing an obstruction- leading to impaired renal function
(hydronephrosis)

29
Q

If a biopsy has proven muscle invasion then how do we investigate further?

Depending on whether it’s invasive or not, how can we classify bladder cancer?

A

We do staging investigations

  • Superficial bladder cancer
  • Muscle invasive bladder cancer
30
Q

When would an MRI be useful in bladder cancer?

A

If we have a TCC in bladder that is carcinoma in situ, it could cause a generalised field change leading to ureter and urethra getting cancer in it too

We can get MRI when we’re unsure if it’s invading the uterus, vagina, bowel or has caused a fistula

31
Q

TNM staging of bladder cancer

A
32
Q

staging bladder cancer

A
33
Q

How does bladder cystoscopy work?

A

Look down the cystoscope down urethra into bladder

34
Q

What technique can we do now along with a cystoscopy in bladder?

A

Transurethral resection of bladder lesion

  • We use heat to cut out all visible bladder tumour
  • This also provides histology and can be curative
35
Q

How do we manage non muscle invasive bladder cancer?

A

If it’s low grade and no CIS (carcinoma in situ) consider cystoscopic surveillance +/intravesicular chemo or BCG

36
Q

How do we manage muscle invasive bladder cancer?

A
  • Cystectomy
  • Radiotherapy
  • +/- chemo
  • Palliative treatment
37
Q

Most common cancer in men in the UK?

A

Prostate cancer

38
Q

What is happening to incidence and mortality rates of prostate cancer?

A

Incidence rising but mortality rates declining

39
Q

Most common type of prostate cancer?

A

> 95% of prostate cancer is adenocarcinoma

40
Q

Prostate cancer risk factors?

A
  • Increasing age
  • Western nations (Scandinavian countries)
  • Ethnicities (African Americans)
41
Q

Prostate cancer clinical features

A
  • Usually asymptomatic unless metastatic
  • Some patients may present with:
    • acute urinary retention
    • hydronephrosis (need to decompress)
    • renal failure
42
Q

How do we detect prostate cancer through blood tests?

A

Levels of PSA

43
Q

What else can cause higher PSA levels other than prostate cancer?

A
  • In an enlarged prostate so it may be increased in UTI or increased volume of prostate
  • Prostatitis
  • BPH
44
Q

Why can enlarged prostate cause high PSA?

A

PSA is made by prostate tissue so it’s prostate-specific but not prostate cancer-specific

45
Q

What do we need in addition to PSA levels to diagnose prostate cancer?

A

Imaging/rectal exam

46
Q

What is the main way now of detecting prostate cancer?

A

MRI prior to biopsy testing

47
Q

What were random prostate biopsies associated with historically?

How have techniques changed?

A

Under-detection of high grade (clinically significant) prostate cancer and over-detection of low grade (clinically insignificant) prostate cancer

It’s proven now that multiparametric MRI before biopsy and MRI targeted biopsy is superior to the previous gold standard of transrectal ultrasonography-guided prostate biopsies

48
Q

After MRI, what is the final stage of diagnosis of prostate cancer?

A
  • Transperineal prostate biopsy- systematic template biopsies of the prostate
  • Widely used in most centres over transrectal biopsies as less risk of infection and able to sample all areas of the prostate
49
Q

TNM staging of prostate cancer

A
50
Q

Image showing T1-4 grading of prostate cancer

A
51
Q

What system do we use to grade prostate cancer?

A
52
Q

How do we treat young and fit patients with high grade prostate cancer?

A

Radical prostatectomy/radiotherapy

53
Q

What do we do post-prostatectomy?

A
    • Monitor PSA (should be undetectable or <0.01ng/ml)
    • If >0.2ng/ml then relapse- then might put them on hormone anti-androgen therapy and radiotherapy
54
Q

How do we treat young and fit patients with low grade prostate cancer?

A

Active surveillance (regular PSA, MRI and Biopsy)

55
Q

How do we treat old/unfit patients with high grade prostate cancer/metastatic disease?

A

Hormone therapy

56
Q

How do we treat old/unfit patients with low grade prostate cancer?

A

Watchful waiting (regular PSA testing)

57
Q

What side effects can prostatectomy/radical surgery have?

A
  • Prostate contains proximal sphincter and through prostatectomy this removes the proximal urethral sphincter and changes urethral length
  • Risk of damage to cavernous nerves (S2-S4 parasympathetic fibres (innervation to bladder and urethra)- can cause erectile dysfunction (parasympathetic causes erection)

Aneesha Flashcards BRS 2 (47 decks)

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