Urological Cancers Flashcards
What is the epidemiology of kidney cancer?
13,100 new kidney cancer cases in the UK every year
7th most common in the UK
Incidence and mortality rates are rising
What are the different types of kidney cancers?
Renal Cell Carcinoma (RCC / adenocarcinoma) = 85%
Transitional cell carcinoma = 10%
Sarcoma / Wilms tumour / other types = 5%
What are the risk factors for kidney cancer?
Smoking Renal failure and dialysis Obesity Hypertension Genetic predisposition with Von Hippel-lindau syndrome - (50% of individuals will develop RCC
How does kidney cancer present clinically?
Haematuria
Loin pain
Palpable mass
Matastatic disease symptoms - bone pain, haemoptysis
What is the red flag symptom clinically for kidney cancer?
Painless haematuria - esp. painless because if it is painful, it is also likely to be an infection etc.
OR
Persistent microscopic haematuria
What is the first line investigation with anyone presenting with the red flag symptoms of (painless OR persistent non-visible microscopic) haematuria?
Painless =
Flexible cystoscopy
CT urogram
Renal function
Persistent non-visible haematuria =
Flexible cystoscopy
USS KUB (ultrasound scan kidneys, ureters, and bladders)
What investigations are done next if the first line imaging shows suspected kidney cancer?
CT renal triple phase
Staging CT chest
Bone scan is symptomatic
How is kidney cancer staged using the TNM staging or Fuhrman grade system?
TNM staging of RCC = T1 – Tumour ≤ 7cm T2 – Tumour >7cm T3 – Extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia T4 – Tumour beyond perinephric fascia into surrounding structures N1 – Met in single regional LN N2 – met in ≥2 regional LN M1 – distant met
Fuhrman grade =
1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated
How is kidney cancer managed?
Patient specific - depends on
Classification of the lesion itself - staging and metastases
Gold standard = excision of partial or whole kidney (takes out ureter too)
AKA partial or radical nephrectomy
When is partial nephrectomy chosen over radical nephrectomy?
Partial = if they have a single functioning kidney, bilateral tumour, multifocal RCC in patients with VHL, a small tumour (T1 tumours up to 7cm) etc.
What is the management for patients with small tumours that are unfit for surgery?
What is the management for patients with metastatic disease?
In patients with small tumours unfit for surgery = cryosurgery (use of extreme cold to destroy abnormal tissues e.g. using liquid nitrogen)
Metastatic disease = Receptor Tyrosine Kinase inhibitors
What is the epidemiology for bladder cancer?
10,200 new bladder cancer cases in the UK every year
11th most common cancer in the UK
Incidence and mortality declining
What are the different types of bladder cancer?
Transitional cell carcinoma = >90%
Squamous Cell Carcinoma = 1-7% (75% SCC where schistosomiasis is endemic)
Adenocarcinoma = 2%
What are the main risk factors for bladder cancer?
Smoking
Occupational exposure e.g. aromatic hydrocarbons, dye industry etc., less of an issue now with better regulations
Radiotherapy - for other conditions
Chronic infections - e.g. long-term catheters, gallstones, schistosomiasis (parasitic flatworms)
How does bladder cancer present clinically?
Haematuria
Suprapubic pain
Lower urinary tract symptoms
Metastatic disease symptoms - bone pain, lower limb swelling