Urological malignancy Flashcards
List the benign renal tumours
Renal cysts
Oncocytoma
Angiomyolipoma
Angiomyolipoma is a type of what?
Hamartoma (i.e normal tissue in the wrong order)
Where is transitional cell carcinoma commonly found?
Bladder (less common the further up the ureter)
How can renal cancer be investigated?
Ultrasound
CT (triple phase contrast)
MRI
Everyone with chronic kidney disease gets what investigation?
USS
How is renal cell cancer typically picked up?
Incidentally
Are renal cysts single or multiple?
Can be either (more commonly single)
What are most benign asymptomatic renal lesions?
Renal cysts
How are renal cysts investigated?
USS Contrast CT (define whether there's enhancement)
Which types of tissue compose of angiomyolipoma?
Blood vessels
Muscles
Fat
How is angiomyolipoma investigated?
CT
What is the issue with angiomyolipoma?
Blood vessels are very fragile so haemorrhage risk
What is Wunderlich’s syndrome?
Risk of spontaneous haemorrhage in angiomyolipoma 4-6cm causing systemic collapse due to retroperitoneal bleeding
How are angiomyolipomas treated?
Embolization
How does an oncocytoma present on CT?
Central scar
How is an oncocytoma diagnosed?
Nephroectomy (high false negative)
What problems does oncocytoma cause?
Mass effects
Will oncocytomas metastasise?
No
How does renal cell carcinoma present clinically? How are they most often picked up?
Classic triad is loin pain, mass, haematuria
Incidentally
What are the paraneoplastic symptoms of renal cell carcinoma? How common are paraneoplastic syndromes in renal syndrome?
Weight loss Anaemia Hypertension Hypercalcaemia Very, very common
Which sex most commonly gets renal cell cancer?
Males
Which age group most commonly get renal cell cancer?
65-75 y/o
What type of cancer is renal/clear cell carcinoma?
Adenocarcinoma (proximal collecting tube)
What is von hippel-lindau syndrome?
Familial syndrome causing multiple renal tumors
How is renal cell cancer diagnosed?
USS (not diagnostic but initial investigation of mass)
CT (triple phase contrast) - diagnostic
Biopsy (high false negative phase)
How is renal cell carcinoma staged?
Robson: 1 - within capsule 2 - invasion into perinephric fat 3 - involvement of regional lymph nodes +/- veins 4 - local spread or distant metastases
Where does renal cell carcinoma most commonly metastase?
Lungs (common!!)
Liver
Bone
Brain (late)
How does renal cell carcinoma commonly spread?
Along the veins (haematogenous)
Lymphatic
How is renal cell carcinoma treated?
Nephrectomy (whole kindney & perinephric fat)
Partial nephrectomy (nephron sparing)
Radiofrequency ablation/cryoablation (
Is adrenal gland removed in renal cell carcinoma?
Only if involved!
Is there a role for adjuvant therapy in metastatic renal cell cancer?
Yes! (but not for non-metastatic disease!)
What determines responsiveness to treatment in metastatic kidney disease?
ECOG performance status
How do VEGF/PGEF inhibitors work? Name one
Limit neovascularisation
Sunitinib
Renal cell carcinoma survival rates depend on what?
Robson staging
Name two pre-malignant cutaneous lesions found on the penis? Where on the penis is each typically found?
Balanitis xerotica obliterans (foreskin)
Leukoplakia (glans)
Squamous cell carcinoma of the penis can fall into which two categories?
In situ
Invasive
What is another name for balanitis xerotica obliterans (BXO)?
Lichenus sclerosus et atrophicus
How does balanitis xerotica obliterans present?
White patches
Fissuring
Bleeding
Scarring
“Tight non-retracting foreskin with white demarcated line”
Where does BXO present?
Penis specifically foreskin –> glans –> urethra
How is BXO treated?
Circumcision
Dilation of external meatus
Glans resurfacing
What is squamous cell carcinoma in situ (in the penis) called?
Erythroplasia of Queyrat (glans, foreskin, shaft)
Bowen’s disease (other genital areas)
How does SCC in situ on the penis present?
Red velvety patches
How is SCC in situ treated?
Circumcision
Topical 5-FU
What must SCC in situ on the penis be differentiated from?
Zoon’s balanitis (simple inflammatory condition)
How does invasive SCC on the penis present?
Older men Raised red area Fungating mass Foul smelling Phimosis
Does invasive SCC on the penis present early or late?
Late - reluctant to tell others
How does phimosis predispose to SCC on the penis?
Poor lifelong hygiene
How is invasive SCC of the penis diagnosed?
Biopsy USS MRI Sentinel node biopsy CT (metastases) Bone scan (symptomatic)
Which age group typically gets SCC in the penis?
Over 80 y/o
What is associated with SCC of the penis?
HPV 16
How is SCC of the penis treated?
Surgery
Inguinal lymphadenectomy
Radiotherapy
Describe the surgical options for treatment of SCC of the penis
Total penectomy
Partial penectomy
+/- reconstruction
Metastatic SCC is treated how?
Surgery
Combined radio and chemotherapy
How are testicular tumours diagnosed?
Examination
USS (sensitive)
Markers
How are testicular tumours treated?
Orchidectomy
What are the different types of germ cell tumours of the testis?
Seminoma (potato)
Teratoma
Intratubular germ cell neoplasia (pre-malignant)
How do testicular tumours present?
Painless
Non-tender
Hard swelling
What investigations are used to stage testicular tumours?
CXR (canon ball metastases)
CT abdomen/thorax
Which markers are useful in the diagnosis of testicular cancer? What else are they useful for?
AFP (NOT seminoma)
HCG (variable mostly teratoma)
LDH (tumour burden)
Monitoring response to treatment
Orchidectomy is an inguinal operation. T/F
True - do NOT go in through scrotum
What MUST be done during an orchidectomy?
Clamping of vessels before removal of testis (prevent spread of tumour)
Who gets testicular tumours?
20-30 y/o (varies between different tumour types)
What increases risk of testicular cancer?
Undescended testis
List the different types of teratoma
Differentiated
Undifferentiated
Intermediate
Trophoblastic (elevated HCG)
How are testicular tumours staged?
TNM S (s for markers)
How are testicular tumours managed?
Seminoma - radiotherapy
Teratoma - chemotherapy
