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Year 2 Uro > Urological Cancers > Flashcards

Urological Cancers Flashcards

1
Q

Describe the epidemiology of kidney cancer?

A

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

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2
Q

What are the types of kidney cancer?

A

85% Renal Cell carcinoma(adenocarcinoma)

10% transitional cell carcinoma

Sarcoma/Wilms tumour/other types(5%)

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3
Q

What are the risk factors for kidney cancer?

A

Smoking
Obesity
Genetics

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4
Q

What are the clinical features of kidney cancer?

A

Painless haematuria/persistent microscopic haematuria - red flag

Loin pain
Palpable mass
Metastatic disease symptoms – bone pain, haemoptysis

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5
Q

What investigations are done in anyone presenting with painless visible haematuria?

A

Flexible cystoscopy
CT urogram
Renal function

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6
Q

What investigations are done in anyone presenting with persistent non visible haematuria?

A

Flexible cystoscopy
US KUB
Less associated with cancer than visible

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7
Q

What investigations are done if kidney cancer is suspected?

A

CT renal triple phase
Staging CT chest
Bone scan if symptomatic

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8
Q

What are the TNM staging guidelines for kidney cancer? (T)

A

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

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9
Q

What are the TNM staging guidelines for kidney cancer? (N)

A

N1 – Met in single regional lymph node

N2 – met in ≥2 regional ly,ph node

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10
Q

What are the TNM staging guidelines for kidney cancer? (M)

A

M1- distant met

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11
Q

What is grading?

A

Looks at histology

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12
Q

How is kidney cancer graded?

A

1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated

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13
Q

What is considered when choosing management of kidney cancer?

A

Patient specific

depends on the ASA status, comorbidities, classification of lesion

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14
Q

What does ASA status assess?

A

How fit a patient is

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15
Q

What is the gold standard treatment for kidney cancer?

A

Excision via:

Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)

OR

Radical Nephrectomy

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16
Q

What can be done in patients who are unfit for surgery with small kidney tumours?

A

Cryosurgery

Freeze the lesion to stop progression

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17
Q

What is the treatment for metastatic kidney cancer?

A

Receptor Tyrosine Kinase inhibitors

Blocks cell signalling pathway - less angiogenesis, less spread

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18
Q

Describe the epidemiology of bladder cancer?

A

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

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19
Q

What are the types of bladder cancer?

A

> 90% transitional cell carcinoma

1-7% squamous cell carcinoma (75% SCC where schistosomiasis is endemic)

Adenocarcinoma(2%)

20
Q

What are the risk factors for bladder cancer?

A

Smoking
Radiotherapy for other cancers
Chronic inflammation e.g. schistosomaisis
Occupational e.g. dye industry

21
Q

What are the clinical features of bladder cancer?

A

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

22
Q

What are the TNM staging guidelines for bladder cancer? (T)

A

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

23
Q

What are the TNM staging guidelines for bladder cancer? (N)

A

N1 – 1 LN below common iliac birufication
N2 - >1 LN below common iliac birufication
N3 – Mets in a common iliac LN

24
Q

What are the TNM staging guidelines for bladder cancer? (M)

A

M1- distant mets

25
Q

How is bladder cancer graded?

A 
G1 = well differentiated
G2 = moderate differentiated
G3 = poorly differentiate
26
Q

What is the management protocol for non-muscle invasive bladder cancer?

A

If low grade and no carcinoma in situ - consideration of cystoscopic surveillance

+/- intravesicular chemotherapy/BCG (elicits inflammatory response to reduce progression of lesion)

27
Q

What is the management protocol for muscle invasive bladder cancer?

A

Cystectomy

Radiotherapy

+/- chemotherapy

Palliative treatment

28
Q

Describe the epidemiology of prostate cancer?

A

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

29
Q

What are the types of prostate cancer?

A

> 95% of prostate cancer is adenocarcinoma

30
Q

What are the risk factors for prostate cancer?

A

Age
Western nations
African-americans

31
Q

What is important about prostate cancer?

A

Often asymptomatic unless metastatic

32
Q

What blood test is done to investigate prostate cancer?

A

PSA is prostate-specific but no prostate-cancer specific

Can be elevated in (UTI, prostatitis)

33
Q

what is now the diagnosis plan for prostate cancer and why?

A

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

34
Q

How is the biopsy conducted for prostate cancer?

A

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

35
Q

What are the TNM staging guidelines for prostate cancer? (T)

A

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

36
Q

What are the TNM staging guidelines for prostate cancer? (N)

A

N1 – regional LN (pelvis)

37
Q

What are the TNM staging guidelines for prostate cancer? (M)

A

M1a- non regional LN
M1b- bone
M1x- other sites

38
Q

How is prostate cancer graded?

A

Gleason score
Since multifocal two scores based on level of differentiation

2-6 = Well differentiated
7 = Moderately differentiated
8 – Poorly differentiated

39
Q

How is prostate cancer treated in a young, fit person? (high and low grade)

A

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

40
Q

Why is there hesitancy to treat low grade lesions?

A

risks of Erectile dysfunction

Urinary incontinence

41
Q

How is prostate cancer treated in an old/unfit person?

A

high grade cancer/Metastatic disease - Hormone therapy (lower testosterone)

Low grade cancer - regular PSA testing

42
Q

What are the potential side effects of prosatectomy?

A

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

43
Q

What is cytoscopy?

A

Telescope examination of the bladder done under GA

Can be used to take biopsies and cauterise

44
Q

What is the difference between watchful waiting and active surveillance?

A

Both monitoring PSA
Active surveillance for those fit for surgery
Watchful waiting - palliative hormone therapy

45
Q

how may bladder tumours be excised?

A

cytoscopy and transurethral resection

uses heat to cut out all visible bladder tumour - histology and curative

Year 2 Uro (5 decks)

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