Urological cancers Flashcards
Types of blood in the urine
Microscopic haematuria
Visible haematuria (more serious)
How to analyse urine
urine dipstick
microscopy to exclude infections
What are three examples of kidney cancer?
85% Renal Cell Carcinoma,
10% Transitional Cell Carcinoma,
5% Sarcoma/other types
What are the risk factors of kidney cancer?
Smoking,
Age
hep C
Obesity,
Dialysis,
BP,
Genes
What are the red flag symptoms of kidney cancer?
Painless (visible) haematuria // Persistent Microscopic Haematuria
What are the additional features of renal cell carcinoma?
Loin pain,
palpable mass,
metastatic symptoms, paraneoplastic symptoms where tumours can release certain hormones. can also result in bone pain
Symptoms of renal cancer
Haematuria
back pain
weight loss
loss of appetite
fatigue
fever
anaemia
night sweats
What are the investigations for painless visible haematuria?
Flexible cytoscopy, CT urogram
What are the investigations of persistent non-visible haematuria?
Flexible Cystoscopy, (not typically used for those under 40)
Ultrasound KUB (with Xray)
What grading can you do for kidney cancer?
Fuhrman Grade
Describe the fuhrman grading process
Fuhrman Grade: 1-4 (1 - well-differentiated / 4 - poorly differentiated)
What staging can you do for kidney cancer
TNM- tumour, node, metastasis
What is the most common management process for kidney cancer?
Excision via:
partial nephrectomy - preserve kidney function
radical nephrectomy
What is the management for patients with small tumours unfit for surgery?
Cryosurgery (cold probe to freeze and destroy tumour)
What is the management for patients with metastatic disease?
Receptor Tyrosine Kinase Inhibitors
What are three examples of bladder cancer?
90% Transitional Cell Carcinoma,
8% Squamous Cell Carcinoma, High incidence in areas where schistosomiasis is endemic
2% Adenocarcinoma
What are the risk factors of bladder cancer?
Smoking,
Bladder Inflammation,
Chronic infection,
Catheterisation,
Radiotherapy,
Drugs (Cyclophosphamide)
What are the red flag symptoms of bladder cancer?
Painless (macroscopic) haematuria
Persistent Microscopic Haematuria
What are the additional features of bladder cancer?
Suprapubic pain,
UTI,
metastatic symptoms - bone pain, lower limb swelling
Symptoms of bladder cancer
Haematuria
irritative symptoms - dysuria, nocturia
obstructive symptoms
What is the classification of bladder cancer?
TNM, WHO Classification
Investigations for bladder cancer
Cystoscopy
Ct urogram
WHO classification process
G1 - G3 (G1 - well differentiated // G3 - poorly differentiated)
What is the problem with CT scans when diagnosing bladder cancer
Cannot differentiate between blood clot and tumour
the resolution is poor .: cystoscopy is used
How can you remove a visible bladder tumour?
Transurethral Resection - uses heat to cut out tumour via cystoscopy
What are the two types of bladder cancer?
Muscle-invasive // Non muscle-invasive
What is the management protocol for non-muscle invasive bladder cancer?
Cystoscopy, Intravesicular chemotherapy
What is the management protocol for muscle invasive bladder cancer?
Cystectomy, Radiotherapy, Palliative treatment
Uretic TCC symptoms
Obstruction to the bladder
renal issues
Main type of prostate cancer
Adenocarcinoma
Risk factors of prostate cancer
age
scandinavian countries
ethnicity - african
family history
obesity
diet
What is the chronicity of prostate cancer like?
Asymptomatic usually until metastatic
What blood test can you do for prostate cancer?
PSA (prostatic specific antigen)
age specific ranges as it increases in size with age
What is the problem with using PSA?
PSA is only prostate-specific (not cancer specific), so elevated in UTI, prostatitis, BPH (benign prostatic hypertrophy)
What imaging would you use for prostate cancer investigations?
MRI
look at diffusion of contrast to show volume of prostate and highlight focal areas of abnormality
What biopsy do you use in prostate cancer investigations?
Trans-perineal Prostate Biopsy
- low risk of infection, allows sample of all areas of the prostate
Classification of prostate cancer
TNM, Gleason Score
Describe the gleason score grading process?
Gleason Score: 2-6 (well differentiated - bad) // 8 - poorly differentiated
Describe the T grades of TNM staging of prostate cancer?
T1 - too small to seen on scan, just felt (1a,b,c based on prevalence in tissue) // T2 - inside of prostate gland (2a,b,c - which side of prostate gland or both) // T3 - broken through prostate capsule (3a,b - just capsule or into seminal vesicles) // T4 - spread into nearby organs or pelvis wall
Describe the N grades of TNM staging of prostate cancer?
N0 - not spread to lymph nodes // N1 - spread to lymph nodes
Describe the M grades of TNM staging of prostate cancer?
M0 - not spread to other parts of the body // M1 - spread outside pelvis (1a,b,c - lymph, bone)
What are the two elements of patient classification that influence management of prostate cancer?
Age/Fitness & Grade of Cancer
What is the management of a young and fit patient with low grade cancer?
Surveillance - PSA, MRI and bone surveillance
What is the management of a young and fit patient with high grade cancer?
Radical prostatectomy & Radiotherapy
What is the management of an old and unfit patient with low grade cancer?
Surveillance - regular PSA
What is the management of an old and unfit patient with high grade cancer?
Hormone Therapy
used for mets/recurrence
What are the two structures that can be damaged in prostatectomy?
Removal of proximal urethral sphincter - results in shorter urethra (risk of utis, urinary retention)
Damage to cavernous nerves - ED, lower bladder innervation issues
Mnemonic for Cancer red flags
Fever
Lethargy
Anorexia
Weight loss
Sweats (at night)
