Urological Malignancies (2) Flashcards
Renal Cell Carcinoma (RCC):
What is it?
What are its 3 most common types?
What are its risk factors?
How does it present?
When should it be suspected?
➊ Adenocarcinoma
➋ • Clear cell (80%)
• Papillary (15%)
• Chromophobe (5%)
➌ • Smoking
• Obesity
• HTN
• End-stage Kidney Failure
➍ • Triad of:
‣ Painless haematuria
‣ Flank pain
‣ Palpable mass
• Non-specific symptoms, such as weight loss, night sweats, fatigue
➎ > 45 yrs with unexplained visible haematuria, either w/o UTI or persisting after treatment of UTI
Where does it commonly metastasise?
→ What will be seen on imaging?
What are the paraneoplastic features of an RCC and how do you investigate for them?
What’s a urological complication that can occur here?
→ Why does this happen?
➊ Lungs
→ Cannonball metastases on CXR
➋ • Polycythaemia - due to unregulated EPO secretion
• Hypercalcaemia - due to secretion of hormone that
mimics PTH
• HTN - due to multiple factors, like increased renin secretion, polycythaemia and physical compression on adjacent vessels
• Stauffer’s syndrome - abnormal LFTs w/o liver metastasis
➌ Varicocele
→ Venous congestion as the tumour compresses the renal vein
N.B. Varicocele is much more common on the left due to anatomy.
What are the investigations to do?
What are the management options?
➊ Staging CT CAP
➋ • 1st line is Partial or Radical Nephrectomy
• If not suitable for surgery, other options include arterial embolisation, cryotherapy, and radiofrequency ablation
Testicular Cancer:
What cell does it arise from?
What are its 2 types?
→ Which has the better prognosis?
What are its risk factors?
How does it present?
➊ Germ cells in testes, which produce sperm
➋ * Seminomas
* Non-seminomas - Mostly teratomas
→ Seminomas
➌ * Younger men 15-35 yrs
* Undescended testes
* Male infertility
* Family hx
➍ Painless testicular lump that’s non-tender, hard, irregular, with no transillumination
N.B. These most commonly metastasise to the para-aortic lymph nodes.
Where does it commonly metastasise?
What are the investigations to do?
What are the management options?
➊ Lymphatics, Liver, Lungs, Brain
➋ • USS of scrotum - confirms diagnosis
• Tumour markers - AFP, Beta-hCG, LDH
• Staging CT - Royal Marsden Staging System is used
➌ • Radical Orchidectomy - a prosthesis can be inserted
• Chemo/Radiotherapy
Bladder Cancer:
What are its 2 types? Which is more common?
What are its risk factors for its most common type?
What are the risk factors for the less common types?
How does it present?
➊ • Transitional cell carcinoma (90%)
• Squamous cell carcinoma
• Adenocarcinoma
➋ • Smoking
• Aromatic amines - found in rubber, dyes, and chemical industry
➌ • Long term catheterisation (10+ yrs)
• Schistosomiasis infection
• Local bowel cancer
➍ • Painless haematuria
• UTI
• Hydronephrosis
• Neuropathic pain on medial thigh - Due to compression of obturator nerve
What are the investigations to do?
What are the surgical management options?
What are the medical management options?
➊ • Cystoscopy w/biopsy - for diagnosis
• Staging - Non-muscle invasive or Muscle-invasive
➋ TURBT (Transurethral resection of bladder tumour)
• Radical cystectomy - Urostomy w/ileal conduit commonly done after this
➌ • Intravesical BCG - stimulates immune system to attack bladder tumour (usually given after the tumour is surgically removed to reduce the risk of recurrence)
• Chemo/radiotherapy
