Urological cancers Flashcards
what are the two forms of haematuria and what has the higher risk of malignancy?
non visible and visible
visible has a higher risk of malignancy and is a symptom of urological cancer
if a patient is over 60 and presents with visible haematuria to their gp, whats the next step for treatment?
attend haematuria clinic, a one stop clinic where you do test so that by the end of the day you know whether they have cancer or not
what do you check in a one stop clinic for suspected urological cancers?
1) history - smoking, occupational exposure (rubber, dyes, paints), past history of radiotherapy
2) examination and DRE in men
3) bloods - U&E, PSA, FBC
4) Urine dip
5) ultrasound of renal tract to detect renal and bladder masses and hydronephrosis
6) flexible cystoscopy, mainly diagnostic as can take biopsies
what cancers do you check for in a one stop haematuria clinic?
look for kidney, bladder and prostate cancer (prostate usually has to be quite bad to cause haematuria)
which is more specific for a UTI, nitrites or leucocytes?
nitrites are more specific
Leucocytes however are more sensitive for UTI
where is a CT Urogram a useful test?
its sensitive for upper tract transition cell carcinomas
when is a flexible cystoscopy not useful?
during active bleeding as views are generally poor (requires washout)
what are 4 causes of haematuria?
tumours
infection
trauma
stones
how are tumours graded and staged?
Grades
G1 - well differentiated
G2 - moderately well differentiated
G3 - poorly differentiated
Staging = TNM staging
Tis, Ti, Ta - in situ, doesn’t invade detrusor muscle. A non invasive bladder cancer. 75%
T2, T3, T4 (basically T2 onwards) - detrusor muscle invasive bladder cancers. 25%
histology from a transurethral resection of bladder tumour is done to do this
what are the treatments for bladder cancer?
1) surgery = radical cystectomy
NB: non cancer reason for bladder removal is a simple cystectomy
2) radiotherapy
how can a bladder tumour be resected?
transurethral resection of a bladder tumour is done with a rigid respect-scope and is done under a general or spinal anaesthetic, then can send to pathology to get a grade and TNM staging
what are the two carcinomas that develop in the kidneys and renal pelvis?
renal cell carcinoma and transitional cell carcinoma (TCC is most common)
what carcinomas develop in the ureter and bladder and what are they associated with?
Transitional cell carcinoma (less commonly squamous cell and adenocarcinoma)
squamous cells are associated with long term catheters, recurrent UTI and bladder stones in the UK
TCC are associated with smoking mainly
why do renal cell carcinomas receive neoadjuvant therapy before operation?
neoadjuvant therapy for 3 months prior to surgery increases benefit by 5% and as success is 50% at 5 years this is a massive benefit
what the types of urinary diversion?
1) ileal conduit/ incontinent diversion/ a urostomy (no control over urine outflow into stoma)
2) continent diversion (can control urine outflow into stoma by inserting catheter yourself)
3) Neobladder - ureters are connected to new bladder made of small bowel and connected to urethra
4) bilateral nephrostomy - potential in people with IBD who have already undergone bowel resection.
what are upper tract tumours usually?
upper tract tumours are usually adenocarcinomas
how are nephrectomy done?
partial nephrectomy is done open or robotically
radical is done laprascopic or open
RADICAL IS DONE TO TREAT RCC, MUSCLE INVASIVE TCC AND SQUAMOUS CELL AND ADENOCARCINOMA OF THE BLADDER
why are kidney removal cuts done in the iliac fossa?
as higher up is more painful as by diaphragm and more risk of infection
why would you do a CT CAB in RCC?
to make sure there is no metastases
what type of CT would you do for stones?
CT kidneys ureters bladder
what test would you do to tell if you were dealing with a RCC or a TCC?
CT urogram and uretoscopy
can also do biopsy and urine cystoscopy
what would you remove in a upper tract TCC?
kidney and ureter
what predisposing conditions of the kidneys can put you at risk of cancer?
horseshoe kidney
polycystic kidney disease
dialysis
how are kidney cysts graded?
Bosniak grading
1 = simple cyst
4 = 90% chance of malignancy.
whats the use of intravesicle BCG in bladder cancers?
reduces progression
what is a paraneoplastic syndrome?
A paraneoplastic syndrome is a syndrome (a set of signs and symptoms) that is the consequence of cancer in the body, but unlike a mass effect, is not due to the local presence of cancer cells.
what are common paraneoplastic syndromes associated with RCC?
hypercalcemia, nonmetastatic hepatic dysfunction, amyloidosis, fever, cachexia, and weight loss
what type of cancer is penile cancer and how does it metastases?
squamous cell carcinoma
usually metastases up groin to lymph nodes where it will then ravel throughout the body
what is Gleason scoring?
way of grading adenocarcinomas in prostate cancers
grade is assigned based on differentiation. the lower grade the better
what is the difference between active surveillance and watchful waiting for prostate cancer?
active surveillance is for low risk disease, monitor PSA and DRE every 6 months, aim of monitoring is to treat radically if disease progresses
watchful waiting is for older patients or with non metastatic co morbidities, the aim of monitoring is palliative with hormones if develops metastases or becomes symptomatic
what are the radical treatment options for prostate cancer?
- radical prostatectomy
- external beam radiotherapy
- brachytherapy
what are some metastatic disease treatments?
- androgen deprivation therapy (testosterone receptor antagonist for 28 days and then a LHRH analogue injection after 14 days, repeated every month)
- early docetaxel chemotherapy
