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Y4 Cancer > Urological Cancers > Flashcards

Urological Cancers Flashcards

1
Q

What are some risk factors for bladder cancer ?

A

Smoking
Occupational and environmental exposures ( aromatic amines - dyes )
Chronic bladder irritation
schistomiasis infection
Age
Family history

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2
Q

How does bladder cancer present ?

A

Painless visible haematuria
Irritative voiding
Obstructive symptoms
Abdominal and pelvic pain
Constipation

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3
Q

What investigations would be required if suspecting bladder cancer ?

A

Urinalysis and cytology
CT of urinary tract
Renal USS
Ureteroscopy

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4
Q

What tests are performed when staging bladder cancer ?

A

CT or MRI abdomen
TURBT with biopsy
CXR
Bone scan if ALP is elevated

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5
Q

What is the recurrence of bladder cancer like ?

A

Non-muscle invasive bladder cancer has a high recurrence after TURBT.

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6
Q

What is the management of non-muscle invasive bladder cancer ?

A

Transurethral resection of the bladder tumour
Surveillance
Intravesical chemotherapy or BCG to reduce the risk of progression to muscle-invasive bladder cancer

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7
Q

What is the management of non-metastatic muscle invasive bladder cancer ?

A

Surgery - cystectomy
Chemotherapy
Radiation therapy

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8
Q

How is metastatic bladder cancer managed ?

A

Systemic therapy - cisplatin based chemotherapy is the gold standard

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9
Q

What are the major functions of the kidney ?

A

Water and electrolyte regulation
Excretion of waste
Acid base regulation
Blood pressure regulation
Regulation of erythrocyte production

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10
Q

What are some risk factors for kidney cancer ?

A

Smoking
Hypertension
Obesity
CKD
Occupational exposure
Chronic hepatitis C infections
Kidney stones

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11
Q

How does kidney cancer present locally ?

A

Flank pain
Palpable mass
Visible haematuria

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12
Q

What are some paraneoplastic syndromes associated with kidney cancer ?

A

Anaemia
Hepatic dysfunction
Hypercalcaemia
Polycythaemia
Hypertension

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13
Q

What are some differentials for a renal mass ?

A

Renal cysts
Renal adenoma
Renal cell carcinoma
Nephroblastoma

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14
Q

What are some features of a renal cyst ?

A

Can be asymptomatic
Abdominal flank pain
Palpable mass
Haematuria
( similar to malignant causes )

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15
Q

What are some risk factors for renal cysts ?

A

Age
Male
HTN
Renal dysfunction

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16
Q

What is the most common renal malignancy ?

A

Renal cell carcinoma

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17
Q

What are the types of renal cell carcinoma ?

A

Clear cell
Papillary
Chromophobe

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18
Q

What is clear cell renal cell carcinoma ?

A

A malignancy arising from the lining of the proximal convoluted tubule and is composed of cells with clear or granular cytoplasm

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19
Q

What is clear cell renal cell carcinoma associated with ?

A

Von Hippel-Lindau disease

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20
Q

What is von Hippel-Lindau disease ?

A

An autosomal dominant multisystem neoplasm disorder that arises to due the deletion of the VHL gene ( a tumour suppressor gene ).

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21
Q

When is Wilms tumour ( nephroblastoma ) most commonly seen ?

A

In children

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22
Q

How does wilms tumour present ?

A

Asymptomatic mass
Abdominal pain
Fever
Haematuria
HTN

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23
Q

What is the management of wilms tumour ?

A

Combination of :
- chemotherapy
- radiation
- surgery

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24
Q

How is a diagnosis of renal cell carcinoma made ?

A

Imaging - renal USS is performed first then a CT
Biopsy

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25
Q

What is the definition of a localised cancer ?

A

Is one that is limited to the tissue or organ where it began and has not spread to nearby lymph nodes or other organs. ( stage 1-2 )

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26
Q

What is the general definition of an advanced cancer ?

A

Is one that is unlikely to be cured or controlled by treatment secondary to features such as : spread to surrounding lymph nodes, tissues or other organs ( stage 3-4 ).

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27
Q

What is the management of a localised renal cell carcinoma ?

A

Radical nephrectomy - larger tumour
Partial nephrectomy
Active surveillance - if low rate of metastasis

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28
Q

What is the management of an advanced renal cell carcinoma ?

A

Immunotherapy
Anti-VEGR therapy

29
Q

What part of the prostate is felt on a DRE ?

A

Peripheral

30
Q

What are some risk factors of prostate cancer ?

A

Age
Ethnicity - black
Genetics - BRCA2
Diet - high fat

31
Q

Why is there a risk of using PSA to screen men for prostate cancer ?

A

Elevated PSA doesn’t always mean cancer
False positive requires additional testing
Overtreatment

32
Q

What can cause an elevated PSA ?

A

Prostate cancer
BPH
Prostatitis
Trauma - DRE, TRUS

33
Q

What causes a decreased PSA ?

A

Finasteride
Prostatectomy
Prostate radiotherapy
Anti-androgen therapy
Obesity

34
Q

What are some differentials for a prostatic mass felt on a DRE ?

A

Prostate cancer
BPH
Prostatitis
Cyst
Prior TURP

35
Q

What are some common presenting symptoms in prostate cancer ?

A

Urinary tract obstruction
haematuria

Advanced cancer symptom - bone pain

36
Q

How is a diagnosis of prostate cancer made ?

A

DRE
PSA
TRUS biopsy
Core needle biopsy

37
Q

What grading system is used for prostate cancer ?

A

Gleason

38
Q

How can prostate cancer spread ?

A

Local
Lymphatic
Haematogenous

39
Q

What is used to stage prostate cancer ?

A

PET / CT scan
Bone scan

40
Q

What is the treatment of localised, low risk prostate cancer ?

A

Watchful waiting
Active surveillance
External beam radiation therapy
Radical prostatectomy ( life expectancy more than 10 years )

41
Q

What is active surveillance in the management of prostate cancer ?

A

The postponement of immediate definitive therapy with the initiation of curative intent treatment if there is clinical evidence of disease progression.

42
Q

What is the goal of active surveillance in the management of prostate cancer ?

A

To avoid treatment related complications for men whose cancers are unlikely to progress.

43
Q

When is watchful waiting an appropriate option for the management of prostate cancer ?

A

Men with low risk prostate cancer
Estimated life expectancy less than 10 years
High risk prostate cancer with low life expectancy + no symptoms

44
Q

When is a radical prostatectomy performed in prostate cancer ?

A

If the entire extent of malignant tissue can be surgically excised with minimal impact on the patients urinary and sexual functions.

45
Q

What are the advantages of performing a radical prostatectomy ?

A

Curative
Complete staging
Reduced patient anxiety

46
Q

What are the disadvantages of performing a radical prostatectomy ?

A

Major surgery
Anaesthetic risk
Side effects - impotence, urinary incontinence, infection, bleeding

47
Q

What are the advantages of external beam radiation therapy in the management of prostate cancer ?

A

Curative
As efficacious as surgery
No surgery necessary

48
Q

What are the disadvantages of external beam radiation therapy in the management of prostate cancer ?

A

No staging required
Longer treatment course
Side effects - fatigue, nausea, skin or hair changes, urinary symptoms

49
Q

When is androgen deprivation therapy given to treat prostate cancer ?

A

Used to block the effects on androgens to slow the rate of prostate cancer
Neoadjuvant therapy
Concurrent with radiotherapy
First line in advanced metastatic cancer

50
Q

What are some potential side effects of anti androgen treatment ?

A

Impotency
Loss of libido
Anaemia
Nausea
Vomiting

51
Q

What is the management of metastatic prostate cancer ?

A

Angrogen deprivation therapy

52
Q

What are the 2 types of testicular cancer ?

A

Germ cell
Non germ cell

53
Q

What are some germ cell testicular cancers ?

A

Seminomas
Mixed germ cell
Non-seminomas

54
Q

What are some non-germ cell tumours ?

A

Leydig cell tumour
Sertoli tumours

55
Q

How do seminomas arise ?

A

They originate from the malignant transformation of a germ cell that has been blocked in spermatogenesis and thus will not mature.

56
Q

What are some features of seminomas ?

A

Rarely metastasise
Cure rate close to 100%
Chemo and radio - sensitive
Can transform into non-seminomas
Appear as light brown multi Nodular masses

57
Q

What can non-seminomas differentiate into ?

A

Choriocarcinoma
Yolk sac tumour

58
Q

What are some features of non-seminomas ?

A

Spread more quickly
Higher capacity for haematogenous spread
Chemo-sensitive

59
Q

What are some risk factors for testicular cancer ?

A

Cryptochidism
Personal or family history of testicular cancer
Hypospadia
HIV infection
Infertility

60
Q

What is cryptorchidism ?

A

Where one or both testicles do not spontaneously descend from the abdomen to the scrotum by 4 months of age.

61
Q

How do germ cell tumours present ?

A

Enlarged testicles
Non-tender and solid testicular mass
Scrotal oedema
Dull pain in groin
Scrotal heaviness

62
Q

How do sertoli and leydig cell tumours present differently to germ cell ?

A

Oestrogen excess - gynaecomastia, impotence and loss of libido

63
Q

If suspecting testicular cancer what investigations should be performed ?

A

Scrotal USS
Serum tumour markers ( AFP or beta-hCG in non-seminomas )
CT abdo pelvis
Histopathology

64
Q

What are some management options for testicular tumours ?

A

Surgery - radical inguinal orchidectomy
Active surveillance
Chemotherapy
Radiotherapy

65
Q

What are some possible side effects of chemotherapy for testicular cancer ?

A

Nausea
Vomiting
Pancytopenia
Anorexia
Weight loss
Diarrhoea

66
Q

What are some side effects of surgery in the treatment for testicular cancer ?

A

Changes in genital appearance
Erectile dysfunction
Retrograde ejaculation
Issues with fertility

67
Q

What are some possible side effects of radiation for the management of testicular cancer ?

A

Fatigue
Skin irritation
Diarrhoea
Infertility
Sexual dysfunction

68
Q

What does high tumour markers in non-seminomas indicate ?

A

Negative prognostic factor

69
Q

Where are common sites of metastasis for prostate cancer ?

A

Liver
Bone
Bladder
Lymph nodes

Y4 Cancer (12 decks)

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