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Urological cancers Flashcards

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
Q

What percentage of RCC are found incidentally?

A

50%

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26
Q

What is the “too late triad” of RCC?

A

Haematuria
Palpable mass
Loin pain

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27
Q

What is the definition of stage 1 RCC?

A

<7cm and limited to kidney

28
Q

What is the definition of stage 2 RCC?

A

> 7cm and limited to the kidney

29
Q

What is the definition of stage 3 RCC?

A

Tumour in major veins or adrenal gland, within Gerota’s fascia, or one regional lymph node involved

30
Q

What is the definition of stage 4 RCC?

A

Tumour beyond Gerota’s fascia or more than one regional lymph node involved

31
Q

Which types of renal cysts are likely to be malignant?

A

Bosniak types 3 and 4

32
Q

What is the management of Bosniak type 2F renal cysts?

A

Follow-up CT and ultrasound for 4 years

33
Q

Give 2 surgical options for early stage RCC

A

Radical nephrectomy

Robot assisted partial nephrectomy

34
Q

Give 2 options for early stage RCC in patients unfit for surgery

A

Cryotherapy

Radiofrequency ablation

35
Q

What is the first line treatment for metastatic or unresectable RCC?

A

Nivolumab and ipilimumab

36
Q

What is the mechanism of action of nivolumab?

A

PD1 inhibitor

37
Q

What is the mechanism of action of ipilimumab?

A

CTLA4 inhibitor

38
Q

What is the mechanism of bevacizumab?

A

VEGF inhibitor

39
Q

What is the mechanism of lenvatinib?

A

Tyrosine kinase inhibitor

40
Q

What is the mechanism of everolimus?

A

mTOR inhibitor

41
Q

From where does Wilms’ tumour originate?

A

Primitive renal tubules and mesenchymal cells

42
Q

How does Wilms’ tumour classically present?

A

Abdominal mass and haematuria

43
Q

What congenital condition is associated with 10% of testicular tumours?

A

Undescended testes

44
Q

What type of tumour is a choriocarcinoma?

A

Non-seminomatous germ cell tumour

45
Q

Which endocrine condition is associated with choriocarcinoma?

A

Secondary hyperthyroidism due to ectopic hCG secretion

46
Q

What is the first line investigation for distinguishing a testicular tumour from a benign lump?

A

Ultrasound

47
Q

Give 2 useful markers in testicular cancer

A

Alpha-fetoprotein

Beta-HCG

48
Q

What is the surgical management of testicular cancer?

A

Radical orchidectomy

49
Q

Which type of testicular cancer is particularly sensitive to radiotherapy?

50
Q

What is the pharmacological management of metastatic non-seminomatous germ cell tumours?

A

3 cycles of bleomycin, cisplatin and etoposide

51
Q

What is the main type of prostate cancer?

A

Adenocarcinoma of the peripheral region

52
Q

Give 3 risk factors for prostate cancer

A

Family history
Genetic mutations e.g. BRCA1/2
Increased testosterone

53
Q

What percentage of prostate cancers present as emergencies?

54
Q

Give 3 indications for a PSA and DRE

A

Man with any LUTS
Man with erectile dysfunction
Man with visible haematuria

55
Q

Give 2 indications for urgent 2 week referral for suspected prostate cancer

A

Prostate feels malignant on DRE

PSA level above age-specific reference range

56
Q

What imaging is used to stage prostate cancer?

57
Q

What imaging is used to detect prostate cancer metastases?

A

CT-PET using prostate specific membrane antigen ligand

58
Q

Which grading system is used to grade prostate cancer?

A

Gleason grading (higher numbers are more aggressive)

59
Q

Give 2 risks of radical prostatectomy

A

Incontinence

Sexual dysfunction

60
Q

What are the side effects of external beam radiotherapy?

A

Collateral damage to the rectum, causing bleeding and diarrhoea, and collateral damage to the bladder, causing urinary irritability and bleeding

61
Q

When is brachytherapy used for prostate cancer?

A

Used in younger men with low grade cancers who want to preserve sexual function

62
Q

What hormonal therapies can be used for metastatic prostate cancer?

A

GnRH agonists e.g. goserelin
Anti-androgens e.g. cyproterone, abiraterone
GnRH antagonists e.g. degarelix

63
Q

What are the 4 “T” stages for prostate cancer

A

T1 – contained within the prostate
T2 – nodule on the surface prostate
T3 – invading seminal vesicle
T4 – invading other structures

64
Q

Give 3 risk factors for penile cancer

A

Chronic irritation
Viral infections
Smegma

65
Q

Give 3 indications for urgent 2 week referral for suspected penile cancer

A

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
Q

What is the management of early stage penile cancer?

A

Radiotherapy

Iridium wires

67
Q

What is the management of late stage penile cancer?

A

Lymph node dissection

Amputation

Urology (6 decks)

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