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Urology > Urological Malignancies > Flashcards

Urological Malignancies Flashcards

1
Q

What type of cancers is Renal Cell Carcinoma?

A

Adenocarcinoma which arises from the epithelial cells lining the renal tubules

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2
Q

What are the risk factors for the development of renal cell carcinoma?

A
  • Being male
  • Increasing age
  • Smoking
  • Obesity
  • Familial syndromes e.g von Hippel Lindau syndrome is a autosomal dominant condition that predisposes individual to benign and malignant tumours including renal cell carcinoma and phaechromocytoma (adrenal tumour)
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3
Q

What system is used to grade renal cell carcinoma?

A

=> Fuhrman grading system:

Grade 1 - tumour cell nuclei closely resemble normal
Grade 4 - tumour cell nuclei are larder and pleomorphic

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4
Q

What system is used to stage Renal Cell Carcinoma?

A

=> TNM system

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5
Q

What are common presentations of renal cell carcinoma?

A
  • Incidental finding on a CT scan
  • Signs of metastatic disease (involving lung or bone)
  • Paraneoplastic syndrome (release of PTH, ACTH, renin, erythropoetin)
  • Varicocoele

=> Following classical clinical presentation triad is uncommon, typically patient only presents with one of these:
- Loin pain, loin mass and haematuria

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6
Q

What type of cancers are the majority of bladder cancers?

A

Urothelial carcinomas arising from the epithelium

=> Transitional cell carcinoma is the same as urothelial carcinoma

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7
Q

What are the risk factors of urothelial carcinoma?

A
  • Smoking

- Industrial exposure to 2-naphthylamine. Only takes affect 15-40 years after initial exposure

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8
Q

How is bladder cancer graded?

A

=> Microscopically using a 3 tier grading system:

Low grade: grade 1 and most of grade 2 tumours
High grade: grade 3 and minority of grade 2 tumours

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9
Q

How is bladder cancer staged?

A

=> TNM system:

Superficial tumours: Ta or T1
Muscle invasive tumours: T2, T3 or T4
CIS is Tis

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10
Q

Based on their stage and grade, how are bladder cancers categorised?

A

=> Low risk bladder cancer - low stage and low grade
=> High risk bladder cancers - high stage and high grade
=> Carcinoma in situ (CIS) - strictly speaking a precancer

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11
Q

What is the histological appearance of low risk bladder cancer? What is the most common presentation of bladder cancer?

A
  • Finger like projections

=> Painless macroscopic haematuria

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12
Q

What is the management of low risk bladder cancer?

A
  • These superficial tumours can be remove at cystoscopy by TURBT (Transurethral resection of a bladder tumour)

=> After removal:

  • High chance of tumour recurring
  • Low chance tumour will transform into a high risk tumour
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13
Q

What is the management of high risk bladder cancer?

A

Cystectomy - removal of bladder

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14
Q

What is the main difference between CIS and low risk bladder cancer?

A

CIS is a flat lesion in which cells display behaviour of malignancy but have not yet invaded the basement membrane. CIS is a PREcancer that has a higher chance of developing into high risk bladder cancer compared to low risk bladder cancer

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15
Q

What are the main investigations to identify CIS?

A

=> Blue light cystoscopy:

  • Hour prior to cystoscopy, Hexyl aminolevulinate (HAL) is inserted into the bladder and taken up by CIS
  • Special blue light is used when cystoscopy is performed
  • CIS stands out from surrounding tissue as it has taken up the inserted dye
  • UNDER NORMAL CYSTOSCOPY, THE CIS LOOKS LIKE A RED PATCH DIFFICULT TO DISTINGUISH FROM SURROUNDING TISSUE

=> Urine cystology

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16
Q

What gene mutations are associated with low risk bladder cancer?

A

HRAS and FGFR3

17
Q

What gene mutations are associated with high risk bladder cancer?

A

TP53 and RB1

18
Q

What are the risk factors of testicular cancer?

A
  • Cryptochidism (condition where one or both testes fail to descend)
  • Intersex syndrome
  • Family history
  • Extra copies of the short arm of chromosome 12
19
Q

What are the main investigations in suspected testicular cancer?

A
  • Ultrasound of testicles (1st line)

- Serum tumour markers

20
Q

Testicular cancers are known as germ cell tumours. What are the two main types of germ cell tumours?

A
  • Seminoma (pure seminoma)

- Non seminomatous GCT

21
Q

What is a seminoma?

A
  • Type of germ cell tumour that arises in the seminiferous tubules
  • Spreads via lymphatics to the para-aortic lymph nodes
22
Q

What is the management of a seminoma?

A
  • Radical orchidectomy (surgery that removes the testicles and spermatic cord)
  • If lymph nodes involved, then chemotherapy is used
23
Q

What are the tumour markers used in testicular cancer investigation?

A

Alpha - fetoprotein
hCG
LDH

24
Q

What is the clinical presentation of testicular cancer?

A
  • Painless lump, pain in minority
  • Does not transluminate
  • Hydrocoele, gynacosmatia
  • Raised serum tumour markers

Urology (5 decks)

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