Urological Cancers Flashcards
Describe the epidemiology of kidney cancer?
13,100 new kidney cancer cases in the UK every year
Kidney cancer is the 7th most common cancer in the UK
Incidence and mortality rising
What are the types of kidney cancer?
85% Renal Cell carcinoma(adenocarcinoma)
10% transitional cell carcinoma
Sarcoma/Wilms tumour/other types(5%)
What are the risk factors for kidney cancer?
Smoking
Obesity
Genetics
What are the clinical features of kidney cancer?
Painless haematuria/persistent microscopic haematuria - red flag
Loin pain
Palpable mass
Metastatic disease symptoms – bone pain, haemoptysis
What investigations are done in anyone presenting with painless visible haematuria?
Flexible cystoscopy
CT urogram
Renal function
What investigations are done in anyone presenting with persistent non visible haematuria?
Flexible cystoscopy
US KUB
Less associated with cancer than visible
What investigations are done if kidney cancer is suspected?
CT renal triple phase
Staging CT chest
Bone scan if symptomatic
What are the TNM staging guidelines for kidney cancer? (T)
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
What are the TNM staging guidelines for kidney cancer? (N)
N1 – Met in single regional lymph node
N2 – met in ≥2 regional ly,ph node
What are the TNM staging guidelines for kidney cancer? (M)
M1- distant met
What is grading?
Looks at histology
How is kidney cancer graded?
1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated
What is considered when choosing management of kidney cancer?
Patient specific
depends on the ASA status, comorbidities, classification of lesion
What does ASA status assess?
How fit a patient is
What is the gold standard treatment for kidney cancer?
Excision via:
Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)
OR
Radical Nephrectomy
What can be done in patients who are unfit for surgery with small kidney tumours?
Cryosurgery
Freeze the lesion to stop progression
What is the treatment for metastatic kidney cancer?
Receptor Tyrosine Kinase inhibitors
Blocks cell signalling pathway - less angiogenesis, less spread
Describe the epidemiology of bladder cancer?
10,200 new bladder cancer cases in the UK every year
Bladder cancer is the 11th most common cancer in the UK
Incidence and mortality declining
What are the types of bladder cancer?
> 90% transitional cell carcinoma
1-7% squamous cell carcinoma (75% SCC where schistosomiasis is endemic)
Adenocarcinoma(2%)
What are the risk factors for bladder cancer?
Smoking
Radiotherapy for other cancers
Chronic inflammation e.g. schistosomaisis
Occupational e.g. dye industry
What are the clinical features of bladder cancer?
Painless haematuria/persistent microscopic haematuria - red flag symptom of all urological cancers
Suprapubic pain
Lower urinary tract symptoms
Metastatic disease symptoms –bone pain, lower limb swelling
What are the TNM staging guidelines for bladder cancer? (T)
Ta – non invasive papillary carcinoma
Tis – carcinoma in situ
T1 – invades subepithelial connective tissue
T2 – invades muscularis propria
T3 – invades perivesical fat
T4 – prostate, uterus, vagina, bowel, pelvic or abdominal wall
What are the TNM staging guidelines for bladder cancer? (N)
N1 – 1 LN below common iliac birufication
N2 - >1 LN below common iliac birufication
N3 – Mets in a common iliac LN
What are the TNM staging guidelines for bladder cancer? (M)
M1- distant mets
How is bladder cancer graded?
G1 = well differentiated G2 = moderate differentiated G3 = poorly differentiate
What is the management protocol for non-muscle invasive bladder cancer?
If low grade and no carcinoma in situ - consideration of cystoscopic surveillance
+/- intravesicular chemotherapy/BCG (elicits inflammatory response to reduce progression of lesion)
What is the management protocol for muscle invasive bladder cancer?
Cystectomy
Radiotherapy
+/- chemotherapy
Palliative treatment
Describe the epidemiology of prostate cancer?
48,500 new prostate cancer cases in the UK every year
Prostate cancer is the most common cancer in men within the UK
Incidence rising but mortality rates declining
What are the types of prostate cancer?
> 95% of prostate cancer is adenocarcinoma
What are the risk factors for prostate cancer?
Age
Western nations
African-americans
What is important about prostate cancer?
Often asymptomatic unless metastatic
What blood test is done to investigate prostate cancer?
PSA is prostate-specific but no prostate-cancer specific
Can be elevated in (UTI, prostatitis)
what is now the diagnosis plan for prostate cancer and why?
MRI prior to biopsy
Huge over-detection of low grade lesions that were not issues
Allows for more specific detection of high grade lesions - better idea of lesion locations
How is the biopsy conducted for prostate cancer?
Trans perineal prostate biopsy:
Systematic template biopsies of the prostate
Widely used in most centres over transrectal biopsies as less risk of infection and able to sample all areas of the prostate
What are the TNM staging guidelines for prostate cancer? (T)
T1 – non palpable or visible on imaging
T2 – palpable tumour
T3 – beyond prostatic capsule into periprostatic fat
T4 – tumour fixed onto adjacent structure/pelvic side wall
What are the TNM staging guidelines for prostate cancer? (N)
N1 – regional LN (pelvis)
What are the TNM staging guidelines for prostate cancer? (M)
M1a- non regional LN
M1b- bone
M1x- other sites
How is prostate cancer graded?
Gleason score
Since multifocal two scores based on level of differentiation
2-6 = Well differentiated
7 = Moderately differentiated
8 – Poorly differentiated
How is prostate cancer treated in a young, fit person? (high and low grade)
High grade cancer - Radical prostatectomy/Radiotherapy
Low grade cancer - Active surveillance ( Regular PSA, MRI and Bx)
Post prostatectomy – monitor PSA ( should be undetectable or <0.01ng/ml). If >0.2ng/ml then relapse
Why is there hesitancy to treat low grade lesions?
risks of Erectile dysfunction
Urinary incontinence
How is prostate cancer treated in an old/unfit person?
high grade cancer/Metastatic disease - Hormone therapy (lower testosterone)
Low grade cancer - regular PSA testing
What are the potential side effects of prosatectomy?
The prostate contains the proximal sphincter
Prostatectomy removes this and changes urethral length.
Risk of damage to cavernous nerves (innervation to bladder and urethra)
Damage to cavernous nerves causes ED
What is cytoscopy?
Telescope examination of the bladder done under GA
Can be used to take biopsies and cauterise
What is the difference between watchful waiting and active surveillance?
Both monitoring PSA
Active surveillance for those fit for surgery
Watchful waiting - palliative hormone therapy
how may bladder tumours be excised?
cytoscopy and transurethral resection
uses heat to cut out all visible bladder tumour - histology and curative
