Urological Cancers - RCC And TCC

Question 1

How does renal cell carcinoma present?

Answer 1

Localised or advanced

• haematuria
• incidental finding on imaging
• rare palpable mass (normal,y means oolycystic kidney)

Advanced:

• large varicocele
• pulmonary/ tumour embolus
• loss weight/ appetite/ symptoms from metastasis
• hypercalcaemia

Question 2

How does transitional cell carcinoma present?

Answer 2

Can be anywhere in urinary tract e.g. kidney, ureter, bladder, urethra

Localised of advanced

• haematuria
• incidental finding on imaging

Advanced:

• loss weight/ appetite/ metastasis symptoms
• DVT
• lymphoedema

Question 3

Differentials for haematuria

Answer 3

Cancer:

• RCC
• bladder cancer (90%TCC)
• upper urinary tract TCC
• advanced prostate carcinoma

Nephrological (glomerular):
Younger ppl
Others:

• stones
• infection
• inflammation
• benign prostatic hyperplasia (large)

Question 4

How is haematuria investigated?

Answer 4

History check

Examination - BP, abdo mass, varicocele, leg swelling, assess prostate

Radiology ultrasound first line/ CT

Urine - culture and sensitivity, cytology (special cases)

Endoscopy - flexible cystoscopy

Bloods - FBC, U&E

Question 5

RCC - epidemiology, spread, treatment

Answer 5

7th most common cancer, 95% all upper urinary tract tumours, males to females 3:2, white ppl, 30% metastases presentation, smoking, obesity, dialysis

Spread: LN metastases, perinephric, (renal vein) IVC spread to right atrium

✅
Localised:
Surveillance, excision (radical nephrectomy open/ laparoscopic, partial nephrectomy open/ robotic), ablation (cryoablation freezing, radiofrequency ablation cooking)

Metastatic: chemo and radio resistant.
Palliative, biological therapies, targeted therapies e.g. sunitinib

Question 6

TCC - epidemiology, treatment, staging

Answer 6

8th most common Male cancer UK, 14th women, males, white, smoking, occupational exposure e.g. rubber/ plastic manufacturer, handling carbon/ crude oil, painters/ mechanics/ printers/ hairdressers. 90% bladder cancers

✅initially- TURBT electric current cuts tumour.
Lower risk non muscle- invasive - check cystoscopies +/- intravesical chemotherapy.
High risk non muscle- invasive - check cytoscopies, intravesical immunotherapy.
Muscle- invasive - neoadjuvent chemotherapy + radical cystectomy/ radiotherapy Or palliative

75% superficial, 20% muscle- invasive 
1- epithelium 
2 - subepithelial CT
3 - muscle
4 - perivesical fat 

Histological grading: slide 25

Question 7

Upper urinary tract TCC - epidemiology, investigations, treatment

Answer 7

Only 5% malignancies of upper urinary tract, smoking, phenacetin abuse, Balkan’s nephropathy

Investigation:
Initial - ultrasound (hydronephritis), CT urogram (filling defect, ureteric stricture), retrograde pyelogram, ureteroscopy (biopsy/ washings for cytology)

✅ standard: nephro-ureterectomy (kidney, fat, ureter, cuff of bladder)
Metastatic: systemic chemotherapy (cisplatin- based), biological therapies (immunotherapy antibodies stop protection), targeting programmed cell death receptor 1