Urological Cancers Flashcards
What is the trend in incidence and mortality for kidney cancer?
Both incidence and mortality are increasing
What is the most common type of kidney cancer?
Renal cell carcinoma
What are some aetiological risk factors for kidney disease?
Smokers
Overweight
Hypertension
Genetic risk factors
What is a red flag for kidney cancer?
Painless/microscopic/persistent haematuria
What are some clinical features of kidney cancer?
Haematuria
Loin pain
Palpable mass
If metastases are presetn bone pain, haemoptysis
What are the investigations for painless visible haematuria?
Flexible cystoscopy
CT urogram
Renal function
What are the investigations for non visible haematuria?
Flexible cystoscopy
US KUB
What are the investigations for suspected kidney cancer?
CT renal triple phase
Staging CT chest
Bone scan if symptomatic
Describe T1-T4 for renal cell carcinoma
T1= tumor less than 7cm T2= tumor greater than 7cm T3= Extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia T4= Tumour beyond perinephric fascia into surrounding structures
Describe N1-N2 for renal cell carcinoma
N1= met in single regional LN N2= met in more than 2 regional LN
What does M1 signify in renal cell carcinoma
Distant metastases
How does Fuhrman’s grade for kidney cancer work?
1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated
What is gold standard treatment for renal cell carcinoma?
Excision via partial nephrectomy or radical nephrectomy
What is treatment for patients with small kidney tumors who aren’t fit for surgery?
Cryosurgery
What is treatment for patients with metastatic kidney cancer?
Receptor tyrosine kinase inhibitors
What is the most common type of bladder cancer?
Transitional cell carcinoma
What is a red flag for bladder cancer?
Painless/microscopic/persistent haematuria
What are clinical features of bladder cancer?
Haematuria
Suprapubic pain
Lower urinary tract symptoms
Metastatic disease symptoms –bone pain, lower limb swelling
Describe Ta-T4 for bladder cancer
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
Describe N1-N3 for bladder cancer
N1 – 1 LN below common iliac birufication
N2 - >1 LN below common iliac birufication
N3 – Mets in a common iliac LN
What does M1 mean for bladder cancer
Distant mets are present
Describe the WHO classification for bladder cancer
G1 = well differentiated G2 = moderate differentiated G3 = poorly differentiated
How are bladder tumors resected?
A transurethral resection of bladder lesion uses heat to cut out all visible bladder tumour.
This provides histology and also can be curative.
How is non muscle invasive bladder cancer treated?
If low grade and no CIS then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG
How is muscle invasive bladder cancer treated?
Cystectomy
Radiotherapy
+/- chemotherapy
Palliative treatment
What is the most common type of prostate cancer?
Adenocarcinoma
What are risk factors for prostate cancer?
Increasing age
Western nations(Scandinavian countries)
Ethnicity(African Americans)
What are clinical features of prostate cancer?
Usually asymptomatic unless metastatic
What blood test is done to investigate prostate cancer? Describe what it indicates
PSA is prostate-specific but no prostate-cancer specific, can be elevated in UTI, prostatitis etc
How is prostate cancer managed?
Imaging prior to biopsy testing via MRI
What is the type of biopsy method used for prostate investigation?
Trans perineal prostate biopsy
Describe what T1-T4 means in prostate cancer staging?
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
Describe what N1 means in prostate cancer staging
Regional LN in pelvis
Describe what M1a-M1x means in bladder cancer staging
M1a- non regional LN
M1b- bone
M1x- other sites
What is the Gleason score in bladder cancer staging? Describe what it means
Since the cancer is multifocal two scores based on level of differentiation can be used
2-6 = Well differentiated
7 = Moderately differentiated
8 – Poorly differentiated (as number gets higher cancer is worse)
How is prostate cancer treated if the patient is young and fit and has a high grade cancer?
Radical prostatectomy/Radiotherapy
How is prostate cancer treated if the patient is young and fit and has a low grade cancer?
Active surveillance ( Regular PSA, MRI and Bx)
What must be done post prostatectomy?
Monitor PSA
What should PSA be post prostatectomy? What value indicates relapse?
Should be undetectable or <0.01ng/ml).
If >0.2ng/ml then relapse
How is prostate cancer treated if the patient is old and unfit and has a high grade cancer/ met disease?
Hormone therapy
How is prostate cancer treated if the patient is old and unfit and has a low grade cancer?
Watchful waiting with regular PSA testing
What are side effects of treatment for prostate cancer?
Prostatectomy removes the proximal urethral sphincter and changes urethral length.
Risk of damage to cavernous nerves (innervation to bladder and urethra
causes erectile dysfunction
What must be done if there is haematuria and why?
Cystoscopy and imaging
