Urological cancers Flashcards
Name some risk factors for kidney cancer.
smoking
obesity
chemotherapy
hypertension
genetics
What type of cancer are the majority of kidney cancers?
renal cell carcinoma (adenocarcinoma)
Apart from renal cell carcinoma (adenocarcinoma), what other types of kidney cancers are there?
transitional cells carcinoma
Sarcoma / Wilms tumour + other types
Name some clinical features of kidney cancer.
painless haematuria (visible or microscopic)
loin pain
palpable mass
metastatic disease symptoms
What are some investigations we can do for painless visible haematuria?
flexible cystoscopy
CT urogram (can’t see bladder very well, so use contract and look at ureters)
renal function (proteinurea, haematuria, urine cytology)
What are some investigations we can do for painless non-visible haematuria?
Flexible cystoscopy
US KUB
What are some investigations we can do for suspected kidney cancer?
CT renal triple phase
staging CT chest
bone scan if symptomatic
Memorise
What is The Fuhrman Nuclear Grade?
a pathology component of renal cell cancers and an independent predictor of cancer-specific survival.
How is the Fuhrman grade scored?
What is the management for kidney cancer?
patient specific
gold standard is excision via:
- partial nephrectomy
or
- radical nephrectomy
What is the management for kidney cancer?
patient specific
gold standard is excision via:
- partial nephractomy
or
- radical nephrectomy
What is nephron/renal sparing surgery?
in a partial nephrectomy — also called kidney-sparing (nephron-sparing) surgery — the surgeon removes a cancerous tumor or diseased tissue and leaves in as much healthy kidney tissue as possible
What is a partial nephrectomy aka?
kidney/nephron-sparing surgery
How do we manage kidney cancer patients who have small tumours, but are unfit for surgery?
cryosurgery
freeze and follow up w/ regular scans
How can we manage kidney cancer patients with metastatic disease?
receptor tyrosine kinase inhibitors
What is the most common type of bladder cancer?
transitional cell carcinoma
(epithelium)
What type of bladder cancer is very aggressive, but is only about 1-7% of cases?
squamous cell carcinoma
Under what specific circumstance is 75% of squamous cell carcinoma of bladder seen?
where schistosomiasis is endemic
Name the 3 types of bladder cancer.
transitional cell carcinoma
squamous cell carcinoma
adenocarcinoma
Name some clinical features of bladder cancer.
painless haematuria / persistent microscopic haematuria
Suprapubic pain
Lower urinary tract symptoms and UTI
Metastatic disease symptoms
What condition of the kidney can occur in advanced bladder cancer?
hydronephrosis
How should we continue investigations in a bladder cancer that has been proven to invade the muscle?
staging investigations
How does WHO classify bladder cancers?
Describe the TNM staging of bladder cancer.
What procedure can provide histology as well as be curative for a bladder lesion?
Cystoscopy + transurethral resection of bladder lesion
We can divide bladder cancer into non-muscle invasive and muscle invasive.
How do we manage each type?
What is BCG?
BCG is a type of immunotherapy drug.
For bladder cancer, BCG is given directly into the bladder (intravesical).
This can make the bladder react in a way that makes the immune system get rid of cancer cells.
What is the most common cancer in the UK for men?
prostate
What type of cancer are the majority of prostate cancers?
adenocarcinoma
Name some clinical features of prostate cancer.
usually asymptomatic unless metastatic
urinary symptoms are actually not that common
but can have metastatic symptoms, like bony pain
What is PSA?
PSA liquifies the ejaculate
it can be tested for in blood tests and it is prostate-specific but not prostate-cancer specific
When can PSA be elevated?
prostate cancer
UTI
prostatitis
BPH
How do we investigate for prostate cancer?
blood tests
multiparametric MRI before biopsy
or
MRI targeted biopsy (gold standard)
transperineal prostate biopsy
How is transperineal prostate biopsy graded?
/10, greater, higher risk
How do we score prostate cancer?
How do we TNM stage prostate cancer?
Prostate cancer management is highly dependent on patient age/comorbidities and stage and grade of prostate cancer:
How do we manage someone who is:
- young and fit with high grade cancer?
- young and fit with low grade cancer?
high grade -> radical prostatectomy / radiotherapy
low grade -> active surveillance (regular PSA, MRI and biopsy)
Prostate cancer management is highly dependent on patient age/comorbidities and stage and grade of prostate cancer:
How do we manage someone who is:
- old and unfit with high grade cancer?
- old and unfit with low grade cancer?
high grade/metastatic disease -> hormone therapy
low grade -> watching waiting (regular PSA)
How do we manage post-prostatectomy?
monitor PSA (should be undetectable or <0.01ng/ml)
if >0.2ng = relapse
What are the treatment side effects of prostatectomy? (4)
The prostate contains the proximal sphincter
Prostatectomy removes the proximal urethral sphincter and changes urethral length
Risk of damage to cavernous nerves (innervation to bladder and urethra)
Damage to cavernous nerves causes ED.
Patients with suspected prostate cancer should undergo _____
MRI imaging
Incidence of testicular cancer is ___
increasing
How does WHO classify testicular cancers by ABC?
A: germ cell tumours
B: sex cord / gonadal stromal
C: miscellanenous
Name some germ cell testicular tumours.
Name some sex cord / gonadal stromal tumours.
Name some miscellaneous tumours.
lymphoma
metastases
rete tumours
paratesticular tumours
mesenchymal (sarcomatous) tumours
How can we classify primary tumours? (pT)
What do these stages mean?
IA
IB
IS
Name the 3 principal serum tumour markers for testicular cancer.
Alpha-fetoprotein (AFP)
B eta subunit of human chorionic gonadotropin (HCG)
Lactate dehydrogenase (LDH)
Describe AFP as a testicular cancer serum tumour marker.
Describe beta-subunit HCG as a testicular cancer serum tumour marker.
Describe LDH as a testicular cancer serum tumour marker.
What are the guidelines for diagnosis and staging of testicular cancer?
How can we diagnose testicular cancer?
What is a surgery to remove a testicle with cancer is called?
a radical inguinal orchiectomy
For a seminoma, what is the pathological prognostic factor in a stage I disease?
tumour size >4cm
rete invasion (stromal)
For a non-seminomatous tumour, what is the pathological prognostic factor in a stage I disease?
- lymphovascular invasion
- presence (and extent) of embryonal carcinoma
What are some symptoms of penile cancer?
- Inability/ difficulty / pain on retracting foreskin
- Spraying of stream
- Obstructive LUTS
- Association with penile cancer
What do we call the condition in which tight foreskin can’t be pulled back over the head of the penis.
phimosis
What do we call an abnormal narrowing of the urethral opening? How can this present physiologically?
meatal stenosis
spraying of stream
What can obstructive LUTS be caused by?
urethral stricture
It is difficult to distinguish penile cancer from ____
benign penile dermatoses
In penile cancer, you should also examine for regional inguinal ______ .
lymphadenopathy
How do we TNM classify penile cancer?
Incidence of penile cancer is ___ in LMIC.
Incidence of testicular cancer is ___ in HIC.
higher
higher
