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Urology > Urological Cancers > Flashcards

Urological Cancers Flashcards

1
Q

When do patients get a 2 week wait referral?

A

Haematuria

  • visible
  • non-visible >50 years

Raised PSA or abnormal DRE

Testis mass

Renal mass

Suspicious penile lesion

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2
Q

What is bladder cancer?

A

Develops from lining of the bladder

Most common tumour in the urinary system

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3
Q

Classification of bladder cancers

A

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

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4
Q

Risk factors for bladder cancer

A

Previous radiotherapy
Smoking
Increasing age
Exposure to hydrocarbons

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5
Q

Clinical features of bladder cancer

A 
Painless haematuria (visible or non-visible)
LUTS
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6
Q

Investigations for suspected bladder cancer

A

Urgent cystoscopy
Biopsy
Ultrasound
CT

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7
Q

Management of bladder cancer

A

Non-muscle-invasive bladder cancer

  • resection via TURBT
  • +/- chemotherapy

Muscle-invasive bladder cancer
- radical cysectomy

Locally advanced or metastatic bladder cancer
- chemotherapy

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8
Q

Pathophysiology of renal cell cancer

A

Adenocarcinoma of the renal cortex

Microscopically

  • polyhedral clear cells
  • dark staining nuclei

Can spread via direct invasion to perinephric tissues

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9
Q

Risk factors for renal cell cancer

A

Smoking
Dialysis
Industrial exposure

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10
Q

Clinical features of renal cell cancer

A

50% are asymptomatic

5-10% = classic triad

  • haematuria
  • flank pain
  • renal mass

Paraneoplastic syndromes

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11
Q

What are paraneoplastic syndromes?

A

Ectopic secretion of hormones of renal cell cancers

Polycythaemia - erythropoeitin
Hypercalcaemia - PTH
Hypertension - renin

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12
Q

Investigations for suspected renal cell cancer

A

Bloods

  • FBC
  • U&Es
  • calcum
  • LFTs
  • CRP

Urinalysis

Ultrasound

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13
Q

Management of renal cell cancer

A

Partial/total nephrectomy

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14
Q

Pathophysiology of prostate cancer

A

Arise from peripheral zone

Influenced by androgens

Majority are adenocarcinomas

  • acinar - glandualr cells
  • ductal - cells lining ducts
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15
Q

Risk factors for prostate cancer

A

Increasing age
Afro-caribbean
Family history

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16
Q

Clinical features of prostate cancer

A

LUTS
Haematuria

Abnormal DRE

17
Q

Investigations for suspected prostate cancer

A

PSA

Biopsy

18
Q

What is PSA?

A

Prostate specific antigen - raised by prostate cancer

Also raised by

  • recent DRE
  • prostatitis
  • BPH
19
Q

What is the Gleason grading system?

A

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

20
Q

Management of prostate cancer

A

Discussed at MDT meeting

Low risk disease - surveillance

Intermediate + high risk disease - radical treatment

Anti-androgen therapy

  • LHRH agonist
  • GnRH agonist
21
Q

Classification of testicular cancer

A

Germ cell tumours (90%)

  • seminoma
  • teratoma

Non-germ cell tumour

  • leydig tumour
  • sertoli tumour
22
Q

Risk factors for testicular cancer

A 
Cryptorchidism - undescended testes 
Positive family history
Subfertility 
HIV
Maternal oestrogen exposure
Testicular atrophy
23
Q

Clinical features of testicular cancer

A

Unilateral painless testicle lump

  • irregular
  • fixed
  • does not transilluminate
24
Q

Investigations for suspected testicular cancer

A

Scrotal ultrasound = first line investigation

Tumour markers

  • AFP
  • B-HCG
  • LDH
25
Q

What is the Royal Marsden classification?

A

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
26
Q

Management of testicuar cancer

A

Radical orchidectomy +/- chemo
- through groin to prevent seeding

Offer semen storage

27
Q

What is the normal PSA?

A

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

Urology (12 decks)

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