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Met3b > Urological malignancies > Flashcards

Urological malignancies Flashcards

1
Q

What are the clinical features of RCC?

A
  • Haematuria
  • Loin pain
  • Loin/abdo mass
  • <10% classic triad: haematuria, pain and abdo mass
  • Signs of metastatic disease → bone pain, night sweats, fatigue, weight loss, dyspnoea and haemoptysis
  • Less common features: pyrexia of unkown origin, VTE, acute varicocele, lower limb oedema
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2
Q

What are the risk factors for developing RCC?

A
  1. Environmental:
    - cigarette, pipe, or cigar smoking
    - tobacco chewing
    - renal failure
    - transplant recipients and dialysis
    - BMI >25
    - HTN
    - occupation asbestos exposure
    - asian migrants to western countries are at increased risk RCC
  2. Anatomical:
    - polycystic kidneys
    - horseshoe kidneys
  3. Genetic:
    - von Hipple Lindau syndrome → around 50% develop RCC
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3
Q

What investigations should be carried out for RCC?

A
  • Renal USS (entire renal tract)
  • CT of abdomen with contrast (renal masses)
  • CT chest
  • Bone scan (DEXA)
  • Bloods: FBC/U&Es/Calcium/LFT
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4
Q

What are the different management options for RCC?

A
  1. Localised:
    - radical or partial nephrectomy (open or laparoscopic)
  2. Locally advanced:
    - radical nephrectomy ± adjuvant treatment
  3. Metastatic:
    - chemotherapy rarely successful
    - tyrosine kinase inhibitors (sunitinib, sorafenib, pazopanib)
    - immunotherapy (hgih dose IL-2)
    - mammalian target of rapamycin (mTOR) inhibitors (everolimus, sirolimus)
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5
Q

What are the clinical features of bladder cancer?

A
  1. Painless macroscopic haematuria (85%)
    - Age >50: 34% have TCC bladder
    - Age <50: 10% have TCC bladder
  2. Microscopic haematuria:
    - Age >50: 7-13% have TCC
    - Age <50: 5% have TCC
  3. LUTS
  4. Recurrent UTIs
  5. Pain
  6. Lower limb swelling
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6
Q

What are the risk factors of bladder cancer?

A
  1. M:F = 2.5:1
  2. Increased age
  3. Smoking (x2-5)
  4. Occupation (rubber/paint and dye manufacture)
  5. Chronic inflammation of bladder mucosa
  6. Schistosomiasis (squamous cell carcinoma)
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7
Q

What are investigations should be carried out for bladder cancer?

A
  1. Persistent microscopic haematuria (2 of 3 dipstick tests) or macroscopic haematuria must be investigated:
    - renal function, urine MC&S, glomerulonephritis screen
    - IV urogram
    - USS renal tract
    - Flexible cystoscopy
    - Urine cytology
    - CT urogram more recently in place of IVU and USS
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8
Q

What are the different management options for bladder cancer?

A
  1. Superficial transurethral resection of bladder tumour - curative in 70%
    - 30% recur (therefore check cystoscopy 3 months)
    - adjuvant treatment:
    (i) intravesical mitomycin (MMC): reduced recurrence rate
    (ii) intravesical BCG: stimulates immune system in ballder wall which attack cancer cells
  2. Muscle invasive TCC:
    - radical cystectomy + urinary diversion
    - radical external beam radiotherapy
    - metastatic disease: chemotherapy combinations include gemcitabine + cisplatin or cisplatin + methotrexate
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9
Q

In what area of the prostate does cancer most often occur?

A 
Peripheral zone (75%)
- 95% adenocarcinoma
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10
Q

What are the clinical features of prostate cancer?

A
  1. majority are asymptomatic
  2. LUTS
  3. haematospermia/haematuria
  4. perineal discomfort
  5. lower limb swelling
  6. anorexia and weight loss
  7. bone pain/pathological fractures
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11
Q

What are the risk factors for prostate cancer?

A
  1. high fat diets

2. smoking

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12
Q

What investigations should be carried out for prostate cancer?

A
  1. PSA

2. Transrectal US guided biopsy

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13
Q

What is the gleason score? What score indicate the following:

(a) well differentiated
(b) moderately differentiated
(c) poorly differentiated

A
  • most common histological pattern seen + the highest grade of tumour histology seen

(a) well differentiated: 2-4
(b) moderately differentiated: 5-7
(c) poorly differentiated: 8-10

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14
Q

What are the management options for prostate cancer?

A
  1. radical prostatectomy - open, laparoscopic, robot-assisted
  2. radical external beam radiotherapy
  3. brachytherapy - implanting and radioactive seeds into prostate
  4. cryotherapy - freezing and thawing of prostate cells to kill malignant tissue
  5. adjuvant hormonal therapy
  6. endocrine therapy:
    (i) medical castration → GnRH analogues (goserelin)
    (ii) Androgen receptor antagonists (bicalutamide, enzalutamide)
    (iii) corticosteroids (prednisolone, dexamethasone)
    (iv) oestrogen
    (v) Cyp 17 inhibitors (Abiraterone)
  7. Chemotherapy: taxanes (docetaxel, cabazetaxel)
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15
Q

What are the options in pallaitive treatment for prostate cancer?

A
  1. palliative radiotherapy
  2. bisphosphonates for bone disease (zoledronate)
  3. RANKL inhibitor for metastatic disease (denosumab)
  4. Analgesics
  5. Blood transfusion for anaemia
  6. Palliative care team support
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16
Q

What is the most common type of testicular tumour?

A

Germ cell tumour (90%)

17
Q

What are the clinical features of testicular cancer?

A
  • painless scrotal lump
  • 5% acute scrotal pain (intra-tumoural haemorrhage)
  • if delay in seeking help, sign of metastases (weight loss, lymphadenopathy, bone pain)_
18
Q

What are the risk factors for testicular cancer?

A
  1. race: icnreased risk of caucasian compared ot Afro-Caribbean
  2. undescended tests (x3-14 risk)
  3. HIV infection
  4. first degree relatives
19
Q

What investigations should be carried out for suspected testicular cancer?

A
  1. Testicular USS:
    - hypoechoic region distorting normal architecture
    - microlithiasis
  2. CT abdomen and chest (staging purposes)
  3. Serum tumour markers:
    - Alpha fetoprotein (AFP)
    - B-hCG
    - Lactate dehydrogenase (LDH)
20
Q

What are the management options for non-seminoma germ cell tumour?

A
  1. Non-metastatic disease:
    - surveillance (25% relapse rate of risk factors)
    - adjuvant chemotherapy if risk factors for relapse → lymphatic/vascular invasion
  2. Metastatic disease:
    - chemotherapy (bleomycin + etoposide + cisplatin)
21
Q

What are the management options for seminoma germ cell tumour?

A
  1. Non-metastatic disease:
    - chemotherapy
    - radiotherapy
    (reduces risk of para-aortic nodal spread to <1%)
  2. Metastatic disease:
    - radiotherapy or chemotherapy
    - retroperitoneal lymph node dissection
22
Q

What are the management options for penile cancer?

A
  1. Surgical removal - including inguinal nodes
  2. Radiotherapy - to draining inguinal nodes
  3. Chemotherapy - cisplatin, fluorouracil, docetaxel

Met3b (21 decks)

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