Urological cancers Flashcards
Testicular cancer classification
Germ cell tumours (95%) - seminomas and non-seminomatous & usually malignant
- seminomas - tend to remain localised until late & have very good prognosis
- NSGCTs - yolk sac tumours, choriocarcinoma, embryonal carcinoma & teratoma; metastasise early & have worse prognosis
Non germ cell tumours (5%) - usually benign, Leydig cell tumours/Sertoli cell tumours
Testicular cancer RFs
Cryptorchidism (undescended testes)
Previous testicular malignancy
Positive family history
Caucasian ethnicity
Kleinfelter’s syndrome
Testicular cancer clinical features
Unilateral painless testicular lump - mass is typically irregular firm, fixed & does not transilluminate
Evidence of mets - weight loss, back pain or dyspnoea
Testicular cancer ix
Tumour markers
- bHCG - elevated in 60% of NSGCTs (100% in choriocarcinomas) & 5-10% pure seminomas
- AFP can be raised in some NSGCTs but not in pure seminomas
- LDH can be used as a surrogate marker for tumour volume and necrosis
Scrotal ultrasound
CT C/A/P for staging
Biopsy not performed due to seeding of the cancer - diagnosis made through tumour markers and imaging alone !
NSGCTs mx
Stage 1 - orchidectomy, then further management based on risk score
- low risk → surveillance
- high risk → adjuvant chemotherapy & then surveillance: regular examination, surveillance CT imaging & plain film chest radiographs & tumour markers
Metastatic NSGCTs is also dependent on risk scoring
- intermediate prognosis - chemotherapy
- poor prognosis - one cycle of chemotherapy before reassessment
Seminomas mx
Stage 1 seminoma can often be managed with orchidectomy alone & surveillance monitoring
Metastatic seminoma, stage IIA can be treated with radiotherapy/chemotherapy whilst higher stage disease will require chemotherapy alone & treated similar to metastatic NSGCTs
Testicular cancer complications
Patients who undergo radiotherapy and chemotherapy → often have an increased risk of secondary malignancies such as leukaemia
Bladder cancer classification
Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
Sarcoma
Further classified into:
- non muscle-invasive bladder cancer
- muscle-invasive bladder cancer
- locally advanced or metastatic bladder cancer
Bladder cancer RFs
Smoking
Increasing age
Aromatic hydrocarbons - industrial dyes or rubbers
Schistosomiasis infection - particularly SCC
Previous radiation to the pelvis
Bladder cancer clinical features
Painless haematuria
Recurrent UTIs
LUTS - frequency, urgency or feeling of incomplete voiding
Bladder cancer ix
Suspected bladder cancer → require urgent cystoscopy
If a suspicious lesion is identified from initial cystoscopy → rigid cystoscopy will be required
Any tumour identified at rigid cystoscopy will require biopsy & potential resection via transurethral resection of bladder tumour (TURBT)
CT imaging
Urine cytology
Non-muscle-invasive bladder cancer mx
Carcinoma in-situ or T1 tumours can typically be resected via TURBT
Higher risk disease - adjuvant intravesical therapy → BCG or mitomycin C
Radical cystectomy can be offered to those with high risk disease/limited response to initial treatments
Muscle-invasive bladder cancer mx
Radical cystectomy
Often also be considered for neoadjuvant chemotherapy
Following radical cystectomy → patients require urinary diversion:
- ileal conduit formation with urine draining via a urostomy
- bladder reconstruction
Patients require regular follow-up with CT imaging to monitor for local and distant recurrence
Locally advanced/metastatic bladder cancer mx
Chemotherapy
Any symptomatic disease - managed appropriately with specialist advice and input through MDT
Palliative options
Renal cancer pathophysiology
Adenocarcinoma of the renal cortex, arising predominantly from the proximal convoluted tubules, most appearing in the upper pole of the kidney
Can spread through direct invasion in to perinephric tissues, adrenal gland, renal vein (tumour thrombosis) or the inferior vena cava
Can spread via lymphatics to pre-aortic and hilar nodes
Can spread via haematogenous spread to the bones, liver, brain & lung
