Urological Cancers

Question 1

What are the 2 categories of urological cancers?

Answer 1

RCC (renal cell carcinoma )

TCC (transitional cell carcinoma)

Question 2

Where can TCC affect?

Answer 2

Renal pelvis
Ureter
Bladder
Urethra

Question 3

Where can RCC affect?

Answer 3

Renal parenchyma

Question 4

How does a localised RCC present?

Answer 4

Haematuria

Incidental finding on imaging

Question 5

How does an advanced RCC present?

Answer 5

Large varicocele
Weight loss
Hypercalcaemia

Question 6

How does a localised TCC present?

Answer 6

Haematuria

Incidental finding on imaging

Question 7

How does an advanced TCC present?

Answer 7

Weight loss
DVT
Lymphoedema

Question 8

How can haematuria be classified?

Answer 8

Visible
Dipstick
Microscopic

Question 9

What are differentials for haemturia?

Answer 9

Cancer 
Stones 
Infection 
Inflammation 
BPH 
Glomerular cause

Question 10

How is haematuria investigated?

Answer 10

History

• smoking
• occupation
• other LUTS
• family history

Examination

• BP
• abdominal mass
• varicocele
• leg swelling
• DRE

Bloods
Urine culture/cytology
Ultrasound KUB
Flexible cystoscopy

Question 11

What are risk factors for RCC?

Answer 11

Smoking
Obesity
Dialysis

Question 12

Where does RCC spread to?

Answer 12

Perinephric spread
Lymph node mets
IVC spread -> RA

Question 13

How is a localised RCC managed?

Answer 13

Surveillance

Excision

• radical nephrectomy
• partial nephrectomy

Ablation

• cryoablation
• radiofrequency ablation

Question 14

What is taken in a radical nephrectomy?

Answer 14

Kidney
Adrenal
Surrounding fat
Upper ureter

Question 15

How is a metastatic RCC managed?

Answer 15

Palliative

- biological therapies - targeting angiogenesis

Question 16

Can RCC be managed with radio or chemo therapy?

Answer 16

No it is resistant

Question 17

What are risk factors for TCC?

Answer 17

Smoking

Occupational exposure

• rubber/plastic manufacture
• handling carbon, crude oil / combustion / smelting
• painters
• mechanics

Question 18

How is a bladder TCC initially managed?

Answer 18

TURBT - transurethral resection of bladder tumour

Question 19

How is a bladder TCC staged?

Answer 19

Stage 1 - epithelium
Stage 2 - Subepithelial connective tissue
Stage 3 - Muscle
Stage 4 - Perivesical fat

Question 20

How is bladder TCC further managed?

Answer 20

Low risk non muscle invasive

• check cystoscopies
• +/- intravesical chemo

High risk non muscle invasive

• check cystoscopies
• intravesical immunotherapy

Muscle invasive

• neoadjuvant chemo
• radical cystectomy

Question 21

What is taken in a radical cystectomy?

Answer 21

Male
- bladder + prostate

Female
- bladder + repro system

Question 22

How do you investigate an upper urinary tract TCC?

Answer 22

USS - hydronephrosis
CT urogram
Ureteroscopy

Question 23

How is an upper urinary tract TCC managed?

Answer 23

Nephro-ureterectomy

Question 24

What is taken in a nephron-ureterectomy?

Answer 24

Kidney
Fat
Ureter
Bladder Cuff

Question 25

What are risk factors for prostate cancer?

Answer 25

Increasing age Family history Ethnicity - black>white>Asian

Question 26

How is prostate cancer screened for?

Answer 26

PSA checked when they present with associated symptoms

Question 27

What can cause a raised PSA?

Answer 27

``` Malignancy Infection Inflammation Large prostate Urinary retention Recent DRE ```

Question 28

How does prostate cancer present?

Answer 28

Urinary symptoms Bone pain Abnormal DRE

Question 29

How is prostate cancer investigated?

Answer 29

DRE PSA Prostate biopsy - transrectal ultrasound guided

Question 30

What is used to grade prostate cancer?

Answer 30

Gleason grade

Question 31

How is localised prostate cancer managed?

Answer 31

Surveillance Radical prostatectomy Radiotherapy

Question 32

How is metastatic prostate cancer managed?

Answer 32

Hormones | Palliation