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Urological cancers Flashcards

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1
Q

Which type of bladder tumour is most common in the West?

A

Transitional cell carcinoma

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2
Q

Which type of bladder tumour is most common in Africa?

A

Squamous cell carcinoma

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3
Q

Give 3 risk factors for transitional cell carcinoma

A

Smoking
Aromatic amines
Pelvic irradiation

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4
Q

Give 2 risk factors for squamous cell bladder carcinoma

A

Chronic cystitis due to UTIs/stones

Schistosomiasis

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5
Q

Which investigations can be done to assess lymph node involvement in bladder cancer?

A

MRI or lymphangiography

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6
Q

What is the surgical procedure of choice in bladder cancer with no muscle invasion?

A

Transurethral resection of bladder tumour

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7
Q

Give 2 drugs that can be used for bladder cancer with no muscle invasion

A

Mitomycin C

BCG

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8
Q

Describe the use of mitomycin C in bladder cancer

A

Introduced into the bladder for 1 hour post-TURBT to reduce recurrence

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9
Q

Describe the indications for intravesical BCG for bladder cancer

A

Multiple small tumours
Carcinoma in situ
High grade tumours that have not invaded the bladder muscle

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10
Q

What is the gold standard surgical management for muscle invasive bladder cancer?

A

Radical cystectomy

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11
Q

What does radical cystectomy also remove in men, besides the bladder?

A

Prostate

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12
Q

What does radical cystectomy also remove in women, besides the bladder?

A

Uterus
Fallopian tubes
Ovaries
Front of the vagina

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13
Q

What survival advantage does post-radical cystectomy chemotherapy give?

A

5%

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14
Q

Give 2 ways the ureters are exteriorised following radical cystectomy

A

Ileal conduit

Neobladder made from a pouch of bowel

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15
Q

What is the management of metastatic bladder cancer?

A

Palliative chemotherapy, radiotherapy and immunotherapy

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16
Q

Give an example of a biological drug used in metastatic bladder cancer

A

Atezolizumab (PDL1 inhibitor)

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17
Q

Give 2 strategies used to relieve symptoms in metastatic bladder cancer

A

Chronic catheterisation or diversion to relieve pain

Alum solution bladder irrigation for intractable haematuria

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18
Q

Give one contraindication of alum solution bladder irrigation

A

Renal failure

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19
Q

Give 3 routes of bladder cancer metastasis

A

Local spread to pelvic structures
Lymphatic spread to para-aortic and iliac lymph nodes
Spread in the bloodstream to the liver and lungs

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20
Q

From where does renal cell carcinoma arise?

A

Renal parenchyma

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21
Q

From where does clear cell RCC arise?

A

Proximal tubule

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22
Q

Give 2 benign lesions that can mimic RCC on CT

A

Oncocytoma

Angiomyolipoma

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23
Q

Give 4 things associated with von Hippel-Lindau syndrome

A

Renal cysts
Clear cell RCC
Retinal and cerebellar haemangioblastoma
Phaeochromocytoma

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24
Q

What percentage of haemodialysis patients develop RCC?

A

15%

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25
What percentage of RCC are found incidentally?
50%
26
What is the "too late triad" of RCC?
Haematuria Palpable mass Loin pain
27
What is the definition of stage 1 RCC?
<7cm and limited to kidney
28
What is the definition of stage 2 RCC?
>7cm and limited to the kidney
29
What is the definition of stage 3 RCC?
Tumour in major veins or adrenal gland, within Gerota's fascia, or one regional lymph node involved
30
What is the definition of stage 4 RCC?
Tumour beyond Gerota's fascia or more than one regional lymph node involved
31
Which types of renal cysts are likely to be malignant?
Bosniak types 3 and 4
32
What is the management of Bosniak type 2F renal cysts?
Follow-up CT and ultrasound for 4 years
33
Give 2 surgical options for early stage RCC
Radical nephrectomy | Robot assisted partial nephrectomy
34
Give 2 options for early stage RCC in patients unfit for surgery
Cryotherapy | Radiofrequency ablation
35
What is the first line treatment for metastatic or unresectable RCC?
Nivolumab and ipilimumab
36
What is the mechanism of action of nivolumab?
PD1 inhibitor
37
What is the mechanism of action of ipilimumab?
CTLA4 inhibitor
38
What is the mechanism of bevacizumab?
VEGF inhibitor
39
What is the mechanism of lenvatinib?
Tyrosine kinase inhibitor
40
What is the mechanism of everolimus?
mTOR inhibitor
41
From where does Wilms' tumour originate?
Primitive renal tubules and mesenchymal cells
42
How does Wilms' tumour classically present?
Abdominal mass and haematuria
43
What congenital condition is associated with 10% of testicular tumours?
Undescended testes
44
What type of tumour is a choriocarcinoma?
Non-seminomatous germ cell tumour
45
Which endocrine condition is associated with choriocarcinoma?
Secondary hyperthyroidism due to ectopic hCG secretion
46
What is the first line investigation for distinguishing a testicular tumour from a benign lump?
Ultrasound
47
Give 2 useful markers in testicular cancer
Alpha-fetoprotein | Beta-HCG
48
What is the surgical management of testicular cancer?
Radical orchidectomy
49
Which type of testicular cancer is particularly sensitive to radiotherapy?
Seminoma
50
What is the pharmacological management of metastatic non-seminomatous germ cell tumours?
3 cycles of bleomycin, cisplatin and etoposide
51
What is the main type of prostate cancer?
Adenocarcinoma of the peripheral region
52
Give 3 risk factors for prostate cancer
Family history Genetic mutations e.g. BRCA1/2 Increased testosterone
53
What percentage of prostate cancers present as emergencies?
10-20%
54
Give 3 indications for a PSA and DRE
Man with any LUTS Man with erectile dysfunction Man with visible haematuria
55
Give 2 indications for urgent 2 week referral for suspected prostate cancer
Prostate feels malignant on DRE | PSA level above age-specific reference range
56
What imaging is used to stage prostate cancer?
MRI
57
What imaging is used to detect prostate cancer metastases?
CT-PET using prostate specific membrane antigen ligand
58
Which grading system is used to grade prostate cancer?
Gleason grading (higher numbers are more aggressive)
59
Give 2 risks of radical prostatectomy
Incontinence | Sexual dysfunction
60
What are the side effects of external beam radiotherapy?
Collateral damage to the rectum, causing bleeding and diarrhoea, and collateral damage to the bladder, causing urinary irritability and bleeding
61
When is brachytherapy used for prostate cancer?
Used in younger men with low grade cancers who want to preserve sexual function
62
What hormonal therapies can be used for metastatic prostate cancer?
GnRH agonists e.g. goserelin Anti-androgens e.g. cyproterone, abiraterone GnRH antagonists e.g. degarelix
63
What are the 4 "T" stages for prostate cancer
T1 – contained within the prostate T2 – nodule on the surface prostate T3 – invading seminal vesicle T4 – invading other structures
64
Give 3 risk factors for penile cancer
Chronic irritation Viral infections Smegma
65
Give 3 indications for urgent 2 week referral for suspected penile cancer
Penile mass or ulcer where STI has been excluded Persistent penile lesion after STI treatment has been completed Unexplained or persistent symptoms affecting the foreskin or glans
66
What is the management of early stage penile cancer?
Radiotherapy | Iridium wires
67
What is the management of late stage penile cancer?
Lymph node dissection | Amputation

Urology (6 decks)

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