Urological Malignancies (Kidney, Bladder, Prostate) Flashcards
What type of malignant tumour occurs in the renal pelvis?
Transitional cell carcinoma
What type of malignant tumour occurs in the renal parenchyma?
Renal cell carcinoma
What is the name for the embryonic tumour which forms in the kidneys?
Nephroblastoma (Wilm’s tumour)
What is the most common intra-abdominal tumour in children?
Nephroblastoma (Wilm’s tumour)
How does a nephroblastoma (Wilm’s tumour) typically present?
Abdominal mass +/- haematuria
What is the most common subtype of renal cell carcinoma?
Clear cell carcinoma
Describe the typical demographic that renal cell carcinomas affect?
More common in males, typically aged around 55
The presence of multifocal or bilateral renal cell carcinomas should raise suspicion of what genetic condition?
Von-Hippel-Lindau syndrome
Local spread of a renal cell carcinoma is most commonly to where?
Renal vein +/- IVC
‘Cannonball’ pulmonary metastases is associated with which urological primary tumour?
Renal cell carcinoma
Where do renal cell carcinomas typically metastasise to?
Bone, liver and lung
What is the typical triad describing the presentation of renal cell carcinoma?
Haematuria (painless), loin pain and a renal mass
Renal cell carcinomas can present with a variety of paraneoplastic syndromes- give some examples of these?
Polycythaemia, hypertension, hypercalcaemia
The appearance of a left sided varicocele in a middle aged man should raise suspicion of what?
Left sided renal cell carcinoma (invading the left renal vein)
What blood test is used to screen for the presence of bony metastases?
ALP
What is the gold standard imaging investigation to confirm a diagnosis of renal cell carcinoma?
CT urogram
What is the most common treatment option for renal cell carcinoma?
Radical nephrectomy
When may a partial nephrectomy be utilised as treatment for renal cell carcinoma?
Only if the tumour is T1 on staging
What can be used in the management of unresectable or metastatic renal cell carcinomas?
Biological therapies e.g. sutinib
All patients with renal cell carcinoma should be followed up for how long to assess for late recurrence?
10 years
What type of drug is sutinib, used in the management of renal cell carcinomas?
Tyrosine kinase inhibitor
A nephroblastoma (Wilm’s tumour) may metastasise early- this is most commonly to where?
Lungs
How is a nephroblastoma (Wilm’s tumour) treated?
Nephrectomy, chemotherapy +/- radiotherapy
90% of bladder tumours are what histological type?
Transitional cell carcinomas
Transitional cell carcinomas can be found where in the urinary tract?
Renal pelvis, ureters and bladder
What are the two main risk factors for development of squamous cell carcinoma of the bladder?
Schistosomiasis infection or bladder calculi
Smoking, occupational exposure to analine dyes, pelvic irradiation and chronic bladder infections all increase the risk of developing which type of cancer of the bladder?
Transitional cell carcinoma
What is the typical demographic of individual affected by transitional cell carcinoma of the bladder?
More common in males, typically aged > 50
75% of transitional cell carcinomas occur in which area of the urinary tract, and can lead to obstruction?
The trigone of the bladder
Where are transitional cell carcinomas of the bladder most likely to metastasise to haematogenously?
Liver and lungs
Which lymph nodes are transitional cell carcinomas of the bladder most likely to metastasise to?
Para-aortic and iliac nodes
What is the most common presentation of bladder cancer?
Painless haematuria
Other than painless haematuria, how else may cancer of the bladder present?
Recurrent UTIs and/or voiding irritability
All cancers of the renal tract may show what abnormality on urine microscopy, other than haematuria?
Sterile pyuria
What two investigations can be diagnostic of bladder cancer?
Cystoscopy + biopsy and CT urogram
How are transitional cell carcinomas of the bladder up to stage T1 treated?
Trans-urethral resection of the bladder
How are transitional cell carcinomas of the bladder treated if stage T2 or T3?
Radical cystectomy +/- chemo/radiotherapy
What investigation is used to follow up those who have been treated for transitional cell carcinoma of the bladder?
Cystoscopy
Within which zone of the prostate gland is cancer most likely to arise?
Peripheral zone
Describe the typical demographic of individuals most likely to be affected by prostate cancer?
Males aged 60-80
What is the most significant risk factor for prostate cancer?
Family history
What histological type of cancer is prostate cancer?
Adenocarcinoma
Which lymph nodes do prostate cancers typically spread to?
Para-aortic and iliac nodes
Where is prostate cancer most likely to metastasise to haematogenously?
Bone (particularly the lumbar vertebrae and pelvis)
What is significant about bony metastases from prostate cancer?
These are sclerotic bone mets (will appear whiter than bone on x-ray)
How are prostate cancers graded?
Gleason’s scoring
What is the range of Gleason’s scores for prostate cancer? A score of what would indicate the worst prognosis?
2-10, a score of 10 indicates the worst prognosis
If a patient is symptomatic with prostate cancer, how will they most likely present?
Progressively worsening lower urinary tract symptoms
How may patients with metastases from prostate cancer present?
Bone pain or spinal cord compression
Why may renal failure occur as a result of prostate cancer?
Bilateral ureteric obstruction
How do prostate cancers typically feel on PR examination?
Hard and irregular
A PSA value of greater than what is considered to be high?
5
What is the most important blood test to perform in individuals with suspected prostate cancer?
PSA
On what investigation is prostate cancer diagnosed?
Trans-rectal ultrasound and biopsy
Once prostate cancer has been diagnosed, what investigations can be used for staging?
Bone scans, x-rays (of pelvis and lumbar spine), CT, MRI
In individuals with prostate cancer, a number of prognostic factors help to determine if watchful waiting or aggressive treatment should be advised. What are these?
Pre-treatment PSA level, TNM stage and Gleason grade
What are the 2 curative treatment options for organ-confined prostate cancer?
Radical prostatectomy or radical radiotherapy
How may radical radiotherapy be delivered for prostate cancer?
External beam or brachytherapy
What structures are removed in a radical prostatectomy?
Prostate gland and seminal vesicles
What are some potential complications of a radical prostatectomy?
Incontinence, erectile dysfunction, bladder neck stenosis
What are some potential complications of radical radiotherapy for prostate cancer?
Irritative urinary tract symptoms, erectile dysfunction, incontinence, GI symptoms
What treatment plan may be particularly useful for individuals with organ confined prostate cancer who are aged > 70 and have low-risk tumours?
Acute surveillance
What is meant by acute surveillance for prostate cancer?
Treatment is initiated once the disease has reached a pre-defined threshold
What is meant by watchful waiting for prostate cancer?
Conservative treatment of the cancer until palliative care is required
What is the curative treatment option for locally advanced prostate cancer?
Radiotherapy with neo-adjuvant hormonal therapy
What treatment can be given to patients with locally advanced prostate cancer who need palliation of symptoms but are unfit for curative treatment?
Hormonal therapy
What medication is used as hormonal therapy for prostate cancer?
GnRH analogues e.g. goserelin
What type of medication should be given alongside a GnRH analogue in the hormonal management of prostate cancer for the first 3 weeks of treatment, to minimise the risk of a tumour flare?
An anti-oestrogen e.g. cyproterone acetate
What treatment option is available for bony metastases and spinal cord compression as a result of prostate cancer?
Radiotherapy
