Urological cancers

Question 1

What is the most common type of kidney cancer?

Answer 1

renal cell carcinoma (adenocarcinoma)- 85%

Question 2

What are the main risk factors for kidney cancer?

Answer 2

• smoking
• obesity
• renal failure
• high bp
• genetics

Question 3

How does kidney cancer present?

Answer 3

• painless haematuria /persistent microscopic haematuria (non-visible)
• loin pain
• palpable mass
• metastatic disease symptoms: bone pain, haemoptysis

Question 4

What investigations would you do for anyone who presents with painless visible haematuria?

Answer 4

• flexible cystoscopy (looking into bladder)
• CT urogram (to rule out kidney or ureter cancer)
• blood test for renal function

Question 5

What investigations would you do for anyone who presents with persistent non-visible haematuria?

Answer 5

• flexible cystoscopy

- ultrasound kidney

Question 6

What scans would you do if you suspected kidney cancer?

Answer 6

• CT renal triple phase
• staging CT chest
• bone scan if symptomatic

Question 7

How do you stage kidney cancer?

Answer 7

TNM staging:
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 lymph node
N2= met in >2 regional lymph nodes
M1= distant met

Question 8

What is Fuhrman grading?

Answer 8

histology to assess how abnormal the cells within a lesion are
1= well differentiated
2= moderate differentiated
3+4= poorly differentiated

Question 9

How do you manage kidney cancer?

Answer 9

• patient specific–> how fit patient is, comorbidities, stage of lesion
• gold standard= radical nephrectomy, or partial nephrectomy (if single kidney, bilateral tumour, T1 tumour…)
• if unfit for surgery w/small tumour–> cryosurgery
• if metastatic disease–> receptor tyrosine kinase inhibitors

Question 10

What is the most common type of bladder cancer?

Answer 10

transitional cell carcinoma (>90%)

but 75% squamous cell carcinoma in areas where schistosomiasis in endemic

Question 11

What are the main risk factors for bladder cancer?

Answer 11

• smoking
• radiotherapy
• chronic inflammation eg. long term catheters, bladder stones
• schistosomiasis
• historically, occupation.g. dye industry

Question 12

How does bladder cancer present?

Answer 12

• painless haematuria/ persistent microscopic haematuria
• suprapubic pain
• lower urinary tract symptoms e.g. inc. frequency of urination
• metastatic disease symptoms: bone pain, lower limb swelling

Question 13

What would you do after finding a lesion in the bladder during a flexible cystoscopy?

Answer 13

do a rigid cystoscopy under GA and take a biopsy- can also excise lesion using heat (transurethral resection)

Question 14

How would you manage bladder cancer that invades muscle?

Answer 14

• if fit, cystectomy
• radiotherapy
• +/- chemotherapy
• palliative treatment

Question 15

How would you manage bladder cancer that is non-muscle invasive?

Answer 15

• if low grade and no carcinoma in situ (CIS)–> regular cystoscopy surveillance
• if new lesions, use heat to excise
• can also use intravesicular chemotherapy e.g. BCG (same as TB vaccine)

Question 16

What is the most common type of prostate cancer?

Answer 16

> 95% adenocarcinoma

Question 17

What are the risk factors for prostate cancer?

Answer 17

• increasing age
• western nations
• ethnicity (African Americans)

Question 18

What is PSA?

Answer 18

• blood test for prostate cancer

- prostate-specific, but not prostate cancer specific, as can be elevated in UTI, prostatitis

Question 19

What imaging should you do for suspected prostate cancer?

Answer 19

MRI- BEFORE biopsy

Question 20

How is prostate cancer graded?

Answer 20

• Gleason score
• take 2 scores and add together, due to variability
• 2-6= well differentiated
• 7= moderately differentiated
• 8= poorly differentiated

Question 21

How would you manage prostate cancer?

Answer 21

• highly dependent on age, comorbidities, stage and grade
• if young and fit–> high grade cancer= radical prostatectomy/radiotherapy… low grade cancer= active surveillance (regular PSA, MRI, biopsy)
• post prostatectomy, monitor PSA (should be undetectable)
• if old/unfit–> high grade cancer/metastatic disease= hormone therapy (lower testosterone)…low grade cancer= watchful waiting (regular PSA)
• N.B. prostatectomy removes internal urethral sphincter+changes urethral length, and risk of damage to cavernous nerves–> incontinence and ED