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Z Year 2 BRS URO > Urological Cancers > Flashcards

Urological Cancers Flashcards

1
Q

How common is 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 different types of kidney cancer?

A
  1. 85% of kidney cancer is Renal Cell carcinoma(adenocarcinoma)
  2. 10% transitional cell carcinoma
  3. Sarcoma/Wilms tumour/other types(5%)(2)
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3
Q

What are the risk factors for kidney cancer?

A
  1. Smoking
  2. Renal failure
  3. dialysis
  4. obesity
  5. hypertension
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4
Q

What is the genetic predisposition for urological cancers?

A

Von Hippel-lindau syndrome (50% of individuals will develop RCC)

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5
Q

What are the clinical features of kidney cancer?

A

Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies

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6
Q

What are the additional features of RCC?

A
  • Loin pain
  • Palpable mass
  • Metastatic disease symptoms –bone pain, haemoptysis
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7
Q

What are the investigations for painless visible haematuria in kidney cancer?

A
  1. Flexible cystoscopy
  2. CT urogram
  3. Renal function
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8
Q

What are the investigations for persistent non visible haematuria in kidney cancer?

A
  1. Flexible cystoscopy

2. US KUB

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9
Q

What are the investigations for suspected kidney cancer?

A
  1. CT renal triple phase
  2. Staging CT chest
  3. Bone scan if symptomatic
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10
Q

What is the T1 staging of RCC?

A

Tumour ≤ 7cm

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11
Q

What is the T2 staging of RCC?

A

Tumour >7cm

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12
Q

What is the T3 staging of RCC?

A

Extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia

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13
Q

What is the T4 staging of RCC?

A

Tumour beyond perinephric fascia into surrounding structures

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14
Q

What is N1 staging of RCC?

A

Met in single regional LN

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15
Q

What is N2 staging of RCC?

A

met in ≥2 regional LN

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16
Q

What is M1 staging of RCC?

A

distant met

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17
Q

What is the Fuhram grade of kidney cancer?

A
  • 1 = well differentiated
  • 2 = moderate differentiated
  • 3 + 4 = poorly differentiated
  • 1-3 based on nuclear size , 4 = presecence of sarcomatoid/rhabdoid differentation
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18
Q

What is the management of kidney cancer?

A
  • Patient specific ( depends on the ASA status, comorbidities, classification of lesion)
  • Gold standard is excision either
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19
Q

What are two types of excision of kidney cancer?

A
  1. Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)
  2. Radical Nephrectomy
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20
Q

What is the treatment for patents with small tumours unfit for surgery?

A

Cryosurgery

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21
Q

What is the management of mestatic disease of kidney cancer?

A

Receptor Tyrosine Kinase inhibitors

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22
Q

How common in 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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23
Q

What are the different types of bladder cancer?

A
  1. > 90% of bladder cancer is transitional cell carcinoma, 1-7% squamous cell carcinoma (75% SCC where schistosomiasis is endemic), 2. Adenocarcinoma(2%)(2)
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24
Q

What are the clinical features of bladder cancer?

A

Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies

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25
Q

What are some additional features of bladder cancer?

A
  1. Suprapubic pain
  2. Lower urinary tract symptoms
  3. Metastatic disease symptoms –bone pain, lower limb swelling
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26
Q

What are the investigations of painless visible haematuria in bladder cancer?

A
  • Flexible cystoscopy
  • CT urogram
  • Renal function
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27
Q

What are the investigations of perisistent microscopic haematuria in bladder cancer?

A

-Flexible cystoscopy
-US KUB
If biopsy proven muscle invasive then staging investigations

28
Q

What is Ta staging in bladder cancer?

A

non invasive papillary carcinoma

29
Q

What is Tis staging in bladder cancer?

A

carcinoma in situ

30
Q

What is T1 staging in bladder cancer?

A

invades subepithelial connective tissue

31
Q

What is T2 staging in bladder cancer?

A

invades muscularis propria

32
Q

What is T3 staging in bladder cancer?

A

invades perivesical fat

33
Q

What is T4 staging in bladder cancer?

A

prostate, uterus, vagina, bowel, pelvic or abdominal wall

34
Q

What is N1 staging in bladder cancer?

A

1 LN below common iliac birufication

35
Q

What is N2 staging in bladder cancer?

A

> 1 LN below common iliac birufication

36
Q

What is N3 staging in bladder cancer?

A

Mets in a common iliac LN

37
Q

What is M1 staging in bladder cancer?

A

distant mets

38
Q

What is the WHO classification of for bladder cancer?

A 
G1 = well differentiated
G2 = moderate differentiated
G3 = poorly differentiated
39
Q

What is a transurtheral resection of bladder lesion?

A
  • uses heat to cut out all visible bladder tumour
    1. provides histology and also can be curative
    2. . if the tumour extends beyond muscle then the resection is incomplete due to the risk of perforating the bladder
40
Q

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

A

If low grade and no CIS then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG

41
Q

What is muscle invasive for management protocol for bladder cancer?

A
  • Cystectomy
  • Radiotherapy
  • +/- chemotherapy
  • Palliative treatment
42
Q

How common is prostate cancer?

A
  • 48,500 new prostate cancer cases in the UK every year (4)
  • Prostate cancer is the most common cancer in men within the UK(4)
  • Incidence rising but mortality rates declining (4)
43
Q

What are the different types of prostate cancer?

A

> 95% of prostate cancer is adenocarcinoma

44
Q

What are the risk factors for prostate cancer?

A
  1. Increasing age
  2. Western nations(Scandinavian countries)
  3. Ethnicity(African Americans)
45
Q

What are the clinical features for prostate cancer?

A

Usually asymptomatic unless metastatic

46
Q

What are the blood tests in prostate cancer investigations?

A
  • PSA is prostate-specific but no prostate-cancer specific

- Can be elevated in (UTI, prostatitis)

47
Q

How is MRI used in prostate cancer investigations?

A
  1. imaging prior to biopsy testing
  2. random biopsies of the prostate were associated with an under detection of high grade (clinically significant) prostate cancer and over detection of low grade(clinically insignificant) prostate cancer
  3. use of risk assessment with multiparametric MRI before biopsy and MRI targeted biopsy is superior to the previous gold standard of transrectal ultrasonography-guided prostate biopsies
48
Q

How is trans perineal prostate biopsy used for prostate cancer investigations?

A
  1. Systematic template biopsies of the prostate
  2. Widely used in most centres over transrectal biopsies as less risk of infection and able to sample all areas of the prostate.
49
Q

What is T1 staging in prostate cancer?

A

non palpable or visible on imaging

50
Q

What is T2 staging in prostate cancer?

A

palpable tumour

51
Q

What is T3 staging in prostate cancer?

A

beyond prostatic capsule into periprostatic fat

52
Q

What is T4 staging in prostate cancer?

A

tumour fixed onto adjacent structure/pelvic side wall

53
Q

What is N1 staging in prostate cancer?

A

regional LN (pelvis)

54
Q

What is M1a staging in prostate cancer?

A

non regional LN

55
Q

What is M1b staging in prostate cancer?

A

bone

56
Q

What is M1x staging in prostate cancer?

A

other sites

57
Q

What is Gleason score in prostate cancer?

A

Since multifocal two scores based on level of differentiation

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

58
Q

What is the management of prostate cancer if young and fit with high grade cancer?

A

Radical prostatectomy/Radiotherapy

59
Q

What is the management of prostate cancer if young and fit with low grade cancer?

A

Active surveillance ( Regular PSA, MRI and Bx)

60
Q

What is the management of prostate cancer?

A
  1. Highly dependent on patient age/comorbidities and stage and grade of prostate cancer
  2. Post prostatectomy – monitor PSA ( should be undetectable or <0.01ng/ml). If >0.2ng/ml then relapse
61
Q

What is the management of prostate cancer if old and unfit with high grade cancer/Metastic disease?

A

Hormone therapy (lower testosterone)

62
Q

What is the management of prostate cancer if old and unfit with low grade cancer?

A

Watchful waiting (regular PSA testing)

63
Q

What are the treatment side effects for prostate cancer?

A
  1. Prostatectomy removes the proximal urethral sphincter and changes urethral length.
  2. Risk of damage to cavernous nerves ( innervation to bladder and urethra)(7)
  3. Damage to cavernous nerves causes ED
64
Q

What does the prostate contain?

A

proximal sphincter

65
Q

What is a red flag symptom of prostate cancer?

A
  • Painless visible haematuria

- all patients should undergo cystoscopy and imaging

66
Q

What is PSA?

A

PSA is prostate specific but not prostate cancer specific

67
Q

What is the aetiology of bladder cancer?

A
  1. Smoking
  2. Radiotherapy
  3. Chronic inflammation
  4. trinchstomitis
    - Smoking, occupational exposure( aromatic hydrocarbons), chronic inflammation of bladder (bladder stones, schistosomiasis, long term catheter), drugs (cyclophosphamide), Radiotherapy

Z Year 2 BRS URO (5 decks)

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