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Cancer care > Urological cancers > Flashcards

Urological cancers Flashcards

1
Q

Prostate cancer epidemiology

A

Commonest cancer in males, 2nd commonest overall

80% of 80yo men have it

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2
Q

What type of cancer is prostate cancer?

A

Adenocarcinoma

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3
Q

RF for prostate cancer

A

FH (esp <60, BRCA2), hormonal factors, commonest in Afro-Caribbean Americans + rare in East Asians

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4
Q

Prostate cancer CF

A
  • 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
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5
Q

Ix in prostate cancer

A
  • PSA
  • TRUS + biopsy
  • Pelvic MRI for extension
  • Bone scan for osteosclerotic mets (affect osteoblasts)
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6
Q

How is prognosis decided for prostate cancer?

A
  • Gleason grade: looks at the shape of the glands
  • Level of PSA
  • Staging with pelvic MRI + TRUS
  • Performance status
  • Hormone sensitivity
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7
Q

How is prostate cancer managed?

A
  • 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
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8
Q

What hormones are used in prostate cancer?

A
  • 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
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9
Q

What type of cancer is bladder cancer?

A
  • Most transitional cell carcinomas
  • Squamous cell carcinomas - a/w schistosomiasis
  • Rarely adenocarcinomas

4th commonest cancer in UK

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10
Q

RF for bladder cancer

A

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!)

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11
Q

CF of bladder cancer

A
  • 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
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12
Q

Staging of bladder cancer

A

TNM
T: how far into bladder wall
Ta is slow growing and fine whereas Tis is hard to treat

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13
Q

Management of bladder cancer

A
  • 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
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14
Q

Renal cell carcinoma

A

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
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15
Q

Transitional cell carcinoma

A

50x less common than the bladder version

Behaves the same but is of the renal pelvis + calyces

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16
Q

Wilms’ tumour

A

A childhood tumour around 3y, p/w abdominal mass, occasionally haematuria
5y survival 90% when do nephrectomy + radiotherapy + chemotherapy

17
Q

What are the types of testicular cancer?

A
  • Germ cell tumours (majority, usually aggressive).
  • Seminomas: peak age 35 except a distinct type in older, almost never mets
  • Non-seminomas: like teratoma (peak 25, tissue can be from all 3 germ cell layers), yolk sac tumour, choriocarcinoma, mixed
  • Sex cord/gonadal stromal tumours
  • Leydig cell tumour: often excess hormone secretion causing precocious puberty or testicualr feminisation
  • Sertoli cell tumour
  • Mixed

*Miscellaneous e.g. lymphoma, leukaemia, mets

18
Q

CF of testicular cancer

A
  • Painless progressively enlarging testicular lump or diffuse enlargement
  • Secondary small hydrocele if capsule involved
  • LN to para-aortic LN (cf scrotal skin-inguinal)
  • Mets often to lungs, esp in teratomas
19
Q

How is testicular cancer diagnosed + treated

A
  • Scrotal US
  • Surgical exploration + do orchidectomy at same time
  • Seminomas - stage 1 may jut be surgery, radiotherapy, or IIb onwards chemo
  • Teratomas - immediately need chemo, may need retroperitoneal LN dissection, 25% relapse within first year
  • mets - chemo
20
Q

What are the tumour markers in testicular cancer?

A
  • Beta-hCG: any tumour, esp poorly-differentiated germ cell tumours
  • Alpha fetoprotein: made by yolk sac, raised usually in teratomas (not raised in seminoma)
  • LDH in metastatic seminoma
21
Q

Penile cancer

A

Rare in developed countries, almost unheard of if circumcised. Is squamous cell carcinoma that invades the urethra + inguinal LN

  • RF: poor hygiene, HPV, elderly, erythroplasia of Queryat (severe dysplasia/carcinoma in situ)
  • CF: irregular lump, bleeding, discharge, ulceration. May be hidden by foreskin
22
Q

Causes of a raised PSA?

A

> 4 abnormal but if 4-10 usually BPH, whereas if >10 then 50% will have cancer

Ca prostate, UTI, BPH, prostatic, acute retention

23
Q

Staging of prostate cancer

A

T1-2 localised
T3 locally advanced - tis is what you can feel on DRE when firm + nodular
T4 - advanced, rose hard

N+M from the MRI pelvis + bone scans

24
Q

Castrate-resistant prostate cancer

A

When insensitive to hormones

Mostly spreads to bone (sclerotic, as osteoblastic so make bone), see hot spots on bone scan

25
Q

Bladder carcinoma in situ

A

Tis on TNM - is actually bad prognosis

Causes malignant cystitis (freq + dysuria) but often misdiagnosed

Rapidly infiltrates widely

Cancer care (13 decks)

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