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Surg Spec (Urology) > Urological Malignancies (Kidney, Bladder, Prostate) > Flashcards

Urological Malignancies (Kidney, Bladder, Prostate) Flashcards

1
Q

What type of malignant tumour occurs in the renal pelvis?

A

Transitional cell carcinoma

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2
Q

What type of malignant tumour occurs in the renal parenchyma?

A

Renal cell carcinoma

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3
Q

What is the name for the embryonic tumour which forms in the kidneys?

A

Nephroblastoma (Wilm’s tumour)

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4
Q

What is the most common intra-abdominal tumour in children?

A

Nephroblastoma (Wilm’s tumour)

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5
Q

How does a nephroblastoma (Wilm’s tumour) typically present?

A

Abdominal mass +/- haematuria

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6
Q

What is the most common subtype of renal cell carcinoma?

A

Clear cell carcinoma

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7
Q

Describe the typical demographic that renal cell carcinomas affect?

A

More common in males, typically aged around 55

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8
Q

The presence of multifocal or bilateral renal cell carcinomas should raise suspicion of what genetic condition?

A

Von-Hippel-Lindau syndrome

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9
Q

Local spread of a renal cell carcinoma is most commonly to where?

A

Renal vein +/- IVC

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10
Q

‘Cannonball’ pulmonary metastases is associated with which urological primary tumour?

A

Renal cell carcinoma

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11
Q

Where do renal cell carcinomas typically metastasise to?

A

Bone, liver and lung

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12
Q

What is the typical triad describing the presentation of renal cell carcinoma?

A

Haematuria (painless), loin pain and a renal mass

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13
Q

Renal cell carcinomas can present with a variety of paraneoplastic syndromes- give some examples of these?

A

Polycythaemia, hypertension, hypercalcaemia

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14
Q

The appearance of a left sided varicocele in a middle aged man should raise suspicion of what?

A

Left sided renal cell carcinoma (invading the left renal vein)

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15
Q

What blood test is used to screen for the presence of bony metastases?

A

ALP

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16
Q

What is the gold standard imaging investigation to confirm a diagnosis of renal cell carcinoma?

A

CT urogram

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17
Q

What is the most common treatment option for renal cell carcinoma?

A

Radical nephrectomy

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18
Q

When may a partial nephrectomy be utilised as treatment for renal cell carcinoma?

A

Only if the tumour is T1 on staging

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19
Q

What can be used in the management of unresectable or metastatic renal cell carcinomas?

A

Biological therapies e.g. sutinib

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20
Q

All patients with renal cell carcinoma should be followed up for how long to assess for late recurrence?

A

10 years

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21
Q

What type of drug is sutinib, used in the management of renal cell carcinomas?

A

Tyrosine kinase inhibitor

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22
Q

A nephroblastoma (Wilm’s tumour) may metastasise early- this is most commonly to where?

A

Lungs

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23
Q

How is a nephroblastoma (Wilm’s tumour) treated?

A

Nephrectomy, chemotherapy +/- radiotherapy

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24
Q

90% of bladder tumours are what histological type?

A

Transitional cell carcinomas

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25
Q

Transitional cell carcinomas can be found where in the urinary tract?

A

Renal pelvis, ureters and bladder

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26
Q

What are the two main risk factors for development of squamous cell carcinoma of the bladder?

A

Schistosomiasis infection or bladder calculi

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27
Q

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?

A

Transitional cell carcinoma

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28
Q

What is the typical demographic of individual affected by transitional cell carcinoma of the bladder?

A

More common in males, typically aged > 50

29
Q

75% of transitional cell carcinomas occur in which area of the urinary tract, and can lead to obstruction?

A

The trigone of the bladder

30
Q

Where are transitional cell carcinomas of the bladder most likely to metastasise to haematogenously?

A

Liver and lungs

31
Q

Which lymph nodes are transitional cell carcinomas of the bladder most likely to metastasise to?

A

Para-aortic and iliac nodes

32
Q

What is the most common presentation of bladder cancer?

A

Painless haematuria

33
Q

Other than painless haematuria, how else may cancer of the bladder present?

A

Recurrent UTIs and/or voiding irritability

34
Q

All cancers of the renal tract may show what abnormality on urine microscopy, other than haematuria?

A

Sterile pyuria

35
Q

What two investigations can be diagnostic of bladder cancer?

A

Cystoscopy + biopsy and CT urogram

36
Q

How are transitional cell carcinomas of the bladder up to stage T1 treated?

A

Trans-urethral resection of the bladder

37
Q

How are transitional cell carcinomas of the bladder treated if stage T2 or T3?

A

Radical cystectomy +/- chemo/radiotherapy

38
Q

What investigation is used to follow up those who have been treated for transitional cell carcinoma of the bladder?

A

Cystoscopy

39
Q

Within which zone of the prostate gland is cancer most likely to arise?

A

Peripheral zone

40
Q

Describe the typical demographic of individuals most likely to be affected by prostate cancer?

A

Males aged 60-80

41
Q

What is the most significant risk factor for prostate cancer?

A

Family history

42
Q

What histological type of cancer is prostate cancer?

A

Adenocarcinoma

43
Q

Which lymph nodes do prostate cancers typically spread to?

A

Para-aortic and iliac nodes

44
Q

Where is prostate cancer most likely to metastasise to haematogenously?

A

Bone (particularly the lumbar vertebrae and pelvis)

45
Q

What is significant about bony metastases from prostate cancer?

A

These are sclerotic bone mets (will appear whiter than bone on x-ray)

46
Q

How are prostate cancers graded?

A

Gleason’s scoring

47
Q

What is the range of Gleason’s scores for prostate cancer? A score of what would indicate the worst prognosis?

A

2-10, a score of 10 indicates the worst prognosis

48
Q

If a patient is symptomatic with prostate cancer, how will they most likely present?

A

Progressively worsening lower urinary tract symptoms

49
Q

How may patients with metastases from prostate cancer present?

A

Bone pain or spinal cord compression

50
Q

Why may renal failure occur as a result of prostate cancer?

A

Bilateral ureteric obstruction

51
Q

How do prostate cancers typically feel on PR examination?

A

Hard and irregular

52
Q

A PSA value of greater than what is considered to be high?

A

5

53
Q

What is the most important blood test to perform in individuals with suspected prostate cancer?

A

PSA

54
Q

On what investigation is prostate cancer diagnosed?

A

Trans-rectal ultrasound and biopsy

55
Q

Once prostate cancer has been diagnosed, what investigations can be used for staging?

A

Bone scans, x-rays (of pelvis and lumbar spine), CT, MRI

56
Q

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?

A

Pre-treatment PSA level, TNM stage and Gleason grade

57
Q

What are the 2 curative treatment options for organ-confined prostate cancer?

A

Radical prostatectomy or radical radiotherapy

58
Q

How may radical radiotherapy be delivered for prostate cancer?

A

External beam or brachytherapy

59
Q

What structures are removed in a radical prostatectomy?

A

Prostate gland and seminal vesicles

60
Q

What are some potential complications of a radical prostatectomy?

A

Incontinence, erectile dysfunction, bladder neck stenosis

61
Q

What are some potential complications of radical radiotherapy for prostate cancer?

A

Irritative urinary tract symptoms, erectile dysfunction, incontinence, GI symptoms

62
Q

What treatment plan may be particularly useful for individuals with organ confined prostate cancer who are aged > 70 and have low-risk tumours?

A

Acute surveillance

63
Q

What is meant by acute surveillance for prostate cancer?

A

Treatment is initiated once the disease has reached a pre-defined threshold

64
Q

What is meant by watchful waiting for prostate cancer?

A

Conservative treatment of the cancer until palliative care is required

65
Q

What is the curative treatment option for locally advanced prostate cancer?

A

Radiotherapy with neo-adjuvant hormonal therapy

66
Q

What treatment can be given to patients with locally advanced prostate cancer who need palliation of symptoms but are unfit for curative treatment?

A

Hormonal therapy

67
Q

What medication is used as hormonal therapy for prostate cancer?

A

GnRH analogues e.g. goserelin

68
Q

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?

A

An anti-oestrogen e.g. cyproterone acetate

69
Q

What treatment option is available for bony metastases and spinal cord compression as a result of prostate cancer?

A

Radiotherapy

Surg Spec (Urology) (8 decks)

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