Urological cancers Flashcards
Prostate cancer epidemiology
Commonest cancer in males, 2nd commonest overall
80% of 80yo men have it
What type of cancer is prostate cancer?
Adenocarcinoma
RF for prostate cancer
FH (esp <60, BRCA2), hormonal factors, commonest in Afro-Caribbean Americans + rare in East Asians
Prostate cancer CF
- LUTS
- Ejaculatory like blood in semen (rare)
- Mets: anaemia, WL, back/skeletal pain
- Incidental finding of hard irregular gland on DRE
- Measurement of PSA after an indication for it
Ix in prostate cancer
- PSA
- TRUS + biopsy
- Pelvic MRI for extension
- Bone scan for osteosclerotic mets (affect osteoblasts)
How is prognosis decided for prostate cancer?
- Gleason grade: looks at the shape of the glands
- Level of PSA
- Staging with pelvic MRI + TRUS
- Performance status
- Hormone sensitivity
How is prostate cancer managed?
- Expectant if microscopic/impalpable, usually when Gleason score is 6 or below
- Treat incontinence + sexual dysfunction
- If localised - radical prostatectomy via robotic surgery or radiotherapy. (external beam or brachytherapy, usually in those wanting to avoid surgery)
- Hormone therapy: try to deprive the androgen receptor, as prostate cancer traps circulating androgens
- Advanced disease: can still survive a long time with locally advanced (androgen deprivation + radiotherapy)
- Metastatic androgen deprivation usually lasts for ~2y then need chemo
- Bone drugs like zolendronic acid + denosumab or radio for painful bony mets
What hormones are used in prostate cancer?
- GnRH agonists e.g. goserelin. Lowers circulating androgens, but in first week they raise LH + testosterone so can cause tumour flare (so combine with an anti-androgen like flutamide)
- Androgen receptor blockers e.g. bicalutamide, enzalutamide
- Androgen synthesis inhibitors
- Steroids + oestrogens
What type of cancer is bladder cancer?
- Most transitional cell carcinomas
- Squamous cell carcinomas - a/w schistosomiasis
- Rarely adenocarcinomas
4th commonest cancer in UK
RF for bladder cancer
Male, smoking (x3-urinary excretion of inhaled carcinogens), industrial carcinogens form rubber/cable/dye industries (now banned but long lag time and 20-60x risk!)
CF of bladder cancer
- Frank painless haematuria - 20% with this have Ca
- Microscopic haematuria - 5% Ca
- Ureteric colic: clots in urine
- Clot retention from bleeding
- Hydronephrosis if near ureter
- Malignant cystitis
- Recurrent UTI
Staging of bladder cancer
TNM
T: how far into bladder wall
Ta is slow growing and fine whereas Tis is hard to treat
Management of bladder cancer
- Tis: poor prognosis, immunotherapy + intravesical BCG, or total cystectomy
- For most others try to remove tumour by TURBT (transurethral resection of bladder tumour), or radical cystectomy with a diversion into a pouch made of ileum anastomosed to the urethra
- T4 usually uncurable
- Intravesical chemotherapy e.g. mitomycin or BCG
- Chemo sometimes neoadjuvant
- Radio for older/unfit pt
Renal cell carcinoma
Characteristically clear cytoplasm of cells, M>F, peak in 50-70, v vascular
- RF: smoking only proven RF; sporadic or a/w familial syndromes like Von Hippel-Lindau
- CF: often asymptomatic, or may have frank/mico haematuria, loin pain or a mass in the flank
- Uncommonly affects function of kidney like polycythaemia from EPO production, HTN from renin production, hypercalcaemia from PTHrp
- Mets to para-aortic LN, IVC, lung (cannonball mets) or isolated met in brain/bone/liver
- US KUB, MRI for staging is best
- M: nephrectomy (unless b/l or the other side has poor renal function), TKis in metastatic. No role for chemo or radio
- Unlike other cancers removing solitary lung or liver mets may cure
Transitional cell carcinoma
50x less common than the bladder version
Behaves the same but is of the renal pelvis + calyces
