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BRS YR2 > Urological Cancers > Flashcards

Urological Cancers Flashcards

1
Q

What are the different types of kidney cancer?

A
  • Renal cell carcinoma (85%)
  • Transitional cell carcinoma (10%)
  • Sarcoma/Wilms/Other (5%)
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2
Q

What are the risk factors of kidney cancer?

A
  • older age
  • smoking
  • renal failure
  • dialysis
  • obesity
  • hypertension
  • Hep C
  • Von Hippel-lindau syndrome (genetic) , 50% develop kidney cancer
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3
Q

What is a red flag symptom of kidney/urological malignancy?

A
  • painless visible haematuria
  • persistant microscopic haematuria
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4
Q

What are the key features of renal cell carcinoma?

A
  • loin pain
  • palpable mass
  • metastatic disease symptoms (bone pain, haemoptysis)
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5
Q

What are the symptoms of renal cancer?

A
  • visible haematuria (pink, red or cola coloured)
  • back pain below ribs
  • unexplained weight/appetite loss
  • fatigue
  • fever
  • lump on your side, belly or lower back
  • anaemia
  • night sweats
  • hypertension
  • hypercalcaemia
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6
Q

What should be done when painless visible haematuria is seen?

A
  • flexible cystoscopy
  • CT urogram
  • Renal function
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7
Q

What should be done when persistent non-visible haematuria is found?

A
  • flexible cystoscopy
  • US KUB
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8
Q

What investigations should be done when kidney cancer is suspected?

A
  • CT renal triple phase
  • staging CT chest
  • bone scan if symptomatic
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9
Q

What is the Fuhrman tumour grading system?

A

1 - well differentiated
2 - moderate differentiated
3+4 - poorly differentiated

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10
Q

What does a classification of T1 of TNM tumour staging mean for kidney cancer?

A

Tumour ≤ 7cm

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11
Q

What does a classification of T2 of TNM tumour staging mean for kidney cancer?

A

Tumour >7cm

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12
Q

What does a classification of T3 of TNM tumour staging mean for kidney cancer?

A

Extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia

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13
Q

What does a classification of T4 of TNM tumour staging mean for kidney cancer?

A

Tumour beyond perinephric fascia into surrounding structures

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14
Q

What does a classification of N1 of TNM tumour staging mean for kidney cancer?

A

Metastasis in single regional LN

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15
Q

What does a classification of N2 of TNM tumour staging mean for kidney cancer?

A

Metastasis in ≥2 regional LN

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16
Q

What does a classification of M1 of TNM tumour staging mean for kidney cancer?

A

distant metastasis

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17
Q

What is the management of kidney cancer dependent on?

A

patient specific, depends on:

  • ASA status
  • Co-morbidities
  • Classification of lesion
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18
Q

What is the gold standard management of kidney cancer?

A

excision via:

  • Partial nephrectomy
  • Radical Nephrectomy
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19
Q

When is a partial nephrectomy done?

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

What is the management of kidney cancer for patients with small tumours unfit for surgery?

A

cryosurgery

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21
Q

What is the management of kidney cancer with metastatic disease?

A
  • receptor tyrosine kinase inhibitors
  • immunotherapy
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22
Q

What are the different types of bladder cancer?

A
  • Transitional cell carcinoma (>90%)
  • squamous cell carcinoma (1-7%) - (75% with endemic schistosomiasis)
  • adenocarcinoma (2%)
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23
Q

What are the risk factors of bladder cancer?

A
  • smoking
  • occupational exposure
  • chronic inflammation of the bladder (stones, schistosomiasis, long term catheter)
  • drugs (cyclophosphamide)
  • radiotherapy
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24
Q

What is a red flag symptom of bladder/urological malignancy?

A
  • painless visible haematuria
  • persistant microscopic haematuria
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25
Q

What are the other clinical features of bladder cancer?

A
  • suprapubic pain
  • lower urinary tract symptoms
  • UTIs
  • metastatic disease symptoms (bone pain, lower limb swelling)
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26
Q

What are the key symptoms of bladder cancer?

A
  • haematuria
  • dysuria
  • nocturia
  • urge incontinence
  • obstructive symptoms when urinating
  • abdominal, bone, flank and pelvic pain
  • anorexia
  • cachexia
  • lower edema
  • renal failure
  • resp symptoms
  • suprapubic palpable mass
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27
Q

What does a classification of T1 of TNM tumour staging mean for bladder cancer?

A

invades subepithelial connective tissue

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28
Q

What does a classification of T2 of TNM tumour staging mean for bladder cancer?

A

invades muscularis propria

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29
Q

What does a classification of T3 of TNM tumour staging mean for bladder cancer?

A

invades perivesical fat

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30
Q

What does a classification of T4 of TNM tumour staging mean for bladder cancer?

A

invades prostate, uterus, vagina, bowel, pelvic or abdominal wall

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31
Q

What does a classification of N1 of TNM tumour staging mean for bladder cancer?

A

1 LN below common iliac birufication

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32
Q

What does a classification of N2 of TNM tumour staging mean for bladder cancer?

A

> 1 LN below common iliac birufication

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33
Q

What does a classification of N3 of TNM tumour staging mean for bladder cancer?

A

Mets in a common iliac LN

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34
Q

What does a classification of M1 of TNM tumour staging mean for bladder cancer?

A

distant mets

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35
Q

What does a classification of Ta of TNM tumour staging mean for bladder cancer?

A

non invasive papillary carcinoma

36
Q

What does a classification of Tis of TNM tumour staging mean for bladder cancer?

A

carcinoma in situ

37
Q

What does a G1 WHO classification of bladder cancer mean?

A

well differentiated

38
Q

What does a G2 WHO classification of bladder cancer mean?

A

moderately differentiated

39
Q

What does a G3 WHO classification of bladder cancer mean?

A

poorly differentiated

40
Q

What happens in a cystoscopy and transurethral resection of bladder lesion

A
  • use of heat to cut out all visible bladder tumour
  • provides histology and possibly curative
  • if tumour extends beyond muscle, resection is incomplete to prevent bladder perforation
41
Q

What does the management of bladder cancer depend on?

A

whether or not it has invaded the muscle

42
Q

What is the management protocol if the bladder tumour is non-muscle invasive?

A

If low grade and no CIS

  • cystoscopic surveillance
  • +/- intravesicular chemotherapy/BCG
43
Q

What is the management protocol if the bladder tumour is muscle invasive?

A
  • Cystectomy
  • Radiotherapy
  • +/- chemotherapy
  • Palliative treatment
44
Q

What type of cancer is prostate cancer?

A

adenocarcinoma (>95%)

45
Q

What are the risk factors of prostatic cancer?

A
  • age
  • western nations (scadivanians)
  • ethnicity (african americans)
  • FHx
  • obesity
  • diet
46
Q

What are the clinical features of prostate cancer?

A

usually asymptomatic unless metastatic

47
Q

What investigations are done when prostate cancer is suspected?

A
  • blood tests
  • MRI
  • Trans perineal prostate biopsy
48
Q

What blood tests are done when prostate cancer is suspected?

A

PSA - prostate specific antigen

49
Q

What is PSA?

A
  • enzyme produced by the prostate
  • detectable levels only produced by prostate tissue
  • may be increased by trauma to the prostate
  • can increased with age since age comes with prostatic enlargment
  • cannot be used alone to diagnose prostate cancer
50
Q

What can cause a raised PSA?

A
  • UTI
  • Prostatitis
  • Benign Prostatic Hyperplasia
  • Prostate cancer
51
Q

What MRIs are done when prostate cancer is suspected?

A

multiparametric MRI

52
Q

What is the current gold standard investigations for detecting prostate cancer?

A
  • multiparametric MRI
  • MRI targeted biopsy
53
Q

What is a Trans perineal prostate biopsy?

A

Systematic template biopsies of the prostate

54
Q

Why are Trans perineal prostate biopsies commonly used?

A
  • less risk of infection
  • able to sample all areas of the prostate.
55
Q

What does a classification of T1 of TNM tumour staging mean for prostate cancer?

A

non palpable or visible on imaging

56
Q

What does a classification of T2 of TNM tumour staging mean for prostate cancer?

A

palpable tumour

57
Q

What does a classification of T3 of TNM tumour staging mean for prostate cancer?

A

beyond prostatic capsule into periprostatic fat

58
Q

What does a classification of T4 of TNM tumour staging mean for prostate cancer?

A

tumour fixed onto adjacent structure/pelvic side wall

- spread to other nearby organs (bladder, pelvic wall, rectum)

59
Q

What does a classification of N1 of TNM tumour staging mean for prostate cancer?

A

regional Lymphnodes (pelvis)

60
Q

What does a classification of M1a of TNM tumour staging mean for prostate cancer?

A

cancer cells in lymphnodes outside the pelvix

61
Q

What does a classification of M1b of TNM tumour staging mean for prostate cancer?

A

cancer cells are found in the bone

62
Q

What does a classification of M1x of TNM tumour staging mean for prostate cancer?

A

cancer has spread to other parts of the body outside the pelvixother sites

63
Q

What does a Gleason score of 2-6 of prostate cancer mean?

A

well differentiated

64
Q

What does a Gleason score of 7 of prostate cancer mean?

A

moderately differentiated

65
Q

What does a Gleason score of 8 of prostate cancer mean?

A

poorly differentiated

66
Q

What does a classification of T1a of TNM tumour staging mean for prostate cancer?

A

cancer is <5% of removed tissue

67
Q

What does a classification of T1b of TNM tumour staging mean for prostate cancer?

A

cancer is >/=5% of removed tissue

68
Q

What does a classification of T1c of TNM tumour staging mean for prostate cancer?

A

found by biopsy (often after a raised PSA level)

69
Q

What does a classification of T2a of TNM tumour staging mean for prostate cancer?

A

cancer is only in 1/2 of one side of the prostate

70
Q

What does a classification of T2b of TNM tumour staging mean for prostate cancer?

A

cancer in more than 1/2 of one side of the prostate (not both)

71
Q

What does a classification of T2c of TNM tumour staging mean for prostate cancer?

A

in both sides of the prostate gland, but still inside the prostate gland

72
Q

What does a classification of T3a of TNM tumour staging mean for prostate cancer?

A

cancer has broken through the capsule of the prostate gland

73
Q

What does a classification of T3b of TNM tumour staging mean for prostate cancer?

A

cancer has spread into the seminal vesicles

74
Q

What does a classification of N0 of TNM tumour staging mean for prostate cancer?

A

nearby lymphnodes don’t contain cancer cells

75
Q

What is the management of prostate cancer dependent on?

A
  • patient age
  • co-morbidities
  • stage and grade of prostate cancer
76
Q

What is the management of prostate cancer if the patient is young and fit with high grade cancer?

A
  • radical prostatectomy
  • radiotherapy
77
Q

What is the management of prostate cancer if the patient is young and fit with low grade cancer?

A

active surveillance

  • PSA, and DRE/quaterly
  • MRI (occasionally biospies)/annually
78
Q

What is the management of prostate cancer if the patient is old and unfit with high grade cancer?

A

hormone therapy

79
Q

What is the management of prostate cancer if the patient is old and unfit with low grade cancer?

A

watchful waiting (regular PSA testing)

80
Q

What should be done post prostatectomy?

A
  • monitor PSA for relapse/6 months

should be undetectable

81
Q

What is an undetectable PSA level?

A

<0.01ng/ml

82
Q

What PSA level would indicate a relapse?

A

> 0.2ng/ml

83
Q

What is the impact of a prostatectomy on continence?

A
  • contains the proximal sphincteric unit
  • removes the proximal urethral sphincter
  • risk of damage to the cavernous nerve impacting bladder function
  • changes in urethral length
84
Q

What is the main treatment for the continence issues cause by a prostatectomy?

A
  • PFE
  • artificial urinary sphincter device
85
Q

What is the impact of cavernous nerve damage?

A
  • erectile dysfunction
  • bladder dysfunction (responsible for bladder and urethra innervation)
86
Q

What is involved in the treatment of erectile dysfunction caused by cavernous nerve damage?

A
  • PDE5 inhibitors
  • prostaglandin E1 injections
  • Penile prosthesis devices

BRS YR2 (67 decks)

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