Urological Cancers Flashcards
When do patients get a 2 week wait referral?
Haematuria
- visible
- non-visible >50 years
Raised PSA or abnormal DRE
Testis mass
Renal mass
Suspicious penile lesion
What is bladder cancer?
Develops from lining of the bladder
Most common tumour in the urinary system
Classification of bladder cancers
Non-muscle-invasive
- does not penetrate deeper levels of the bladder wall
Muscle-invasive
- penetrates into the deeper layers of the bladder wall
Locally advanced or metastatic
- spreading beyond bladder and distally
Risk factors for bladder cancer
Previous radiotherapy
Smoking
Increasing age
Exposure to hydrocarbons
Clinical features of bladder cancer
Painless haematuria (visible or non-visible) LUTS
Investigations for suspected bladder cancer
Urgent cystoscopy
Biopsy
Ultrasound
CT
Management of bladder cancer
Non-muscle-invasive bladder cancer
- resection via TURBT
- +/- chemotherapy
Muscle-invasive bladder cancer
- radical cysectomy
Locally advanced or metastatic bladder cancer
- chemotherapy
Pathophysiology of renal cell cancer
Adenocarcinoma of the renal cortex
Microscopically
- polyhedral clear cells
- dark staining nuclei
Can spread via direct invasion to perinephric tissues
Risk factors for renal cell cancer
Smoking
Dialysis
Industrial exposure
Clinical features of renal cell cancer
50% are asymptomatic
5-10% = classic triad
- haematuria
- flank pain
- renal mass
Paraneoplastic syndromes
What are paraneoplastic syndromes?
Ectopic secretion of hormones of renal cell cancers
Polycythaemia - erythropoeitin
Hypercalcaemia - PTH
Hypertension - renin
Investigations for suspected renal cell cancer
Bloods
- FBC
- U&Es
- calcum
- LFTs
- CRP
Urinalysis
Ultrasound
Management of renal cell cancer
Partial/total nephrectomy
Pathophysiology of prostate cancer
Arise from peripheral zone
Influenced by androgens
Majority are adenocarcinomas
- acinar - glandualr cells
- ductal - cells lining ducts
Risk factors for prostate cancer
Increasing age
Afro-caribbean
Family history
Clinical features of prostate cancer
LUTS
Haematuria
Abnormal DRE
Investigations for suspected prostate cancer
PSA
Biopsy
What is PSA?
Prostate specific antigen - raised by prostate cancer
Also raised by
- recent DRE
- prostatitis
- BPH
What is the Gleason grading system?
Prostate cancers are graded based upon histological appearance
1 = small uniform glands 2= more stroma between glands 3 = distinctly infiltrative margins 4 = irregular masses of neoplastic glands 5 = only occaisional gland formation
Primary grade = largest area
Secondary grade = next largest area
Grade = primary + secondary
= 6 - likely to grow slowly
7 - intermediate risk
8-10 - high risk
Management of prostate cancer
Discussed at MDT meeting
Low risk disease - surveillance
Intermediate + high risk disease - radical treatment
Anti-androgen therapy
- LHRH agonist
- GnRH agonist
Classification of testicular cancer
Germ cell tumours (90%)
- seminoma
- teratoma
Non-germ cell tumour
- leydig tumour
- sertoli tumour
Risk factors for testicular cancer
Cryptorchidism - undescended testes Positive family history Subfertility HIV Maternal oestrogen exposure Testicular atrophy
Clinical features of testicular cancer
Unilateral painless testicle lump
- irregular
- fixed
- does not transilluminate
Investigations for suspected testicular cancer
Scrotal ultrasound = first line investigation
Tumour markers
- AFP
- B-HCG
- LDH
What is the Royal Marsden classification?
Staging of testicular cancer
I = disease confined to testes II = infra-diaphragmatic lymph node involvement III = supra+infra-diaphragmatic node involvement IV = extralymphatic metastatic spread
Management of testicuar cancer
Radical orchidectomy +/- chemo
- through groin to prevent seeding
Offer semen storage
What is the normal PSA?
Normal PSA
- 40-49 = <2.5 ng/ml
- 50-59 = <3.5 ng/ml
- 60-69 = <4.5 ng/ml
- > 70 = <6.5 ng/ml
