Urological Malignancy

Question 1

What is the main cancerous kidney tumour

Answer 1

Renal cell carcinoma (clear cell)

Question 2

What are the two benign renal tumours

Answer 2

Oncocytoma

Angiomyolipoma

Question 3

What are the two types of penile cancer

Answer 3

Squamous cell carcinoma

Carcinoma in situ

Question 4

What are the two forms of testicular tumours

Answer 4

Seminoma

Teratoma

Question 5

Where is the most common location for transitional cell carcinoma to occur

Answer 5

Renal pelvis

Bladder

Question 6

Where is the most common location for renal cell carcinoma to occur

Answer 6

Renal parenchyma

Question 7

What is the embryological form of a renal tumour

Answer 7

Nephroblastoma (Wilm’s tumour)

Question 8

What investigation is good at identifying a fluid filled lesion

Answer 8

US

Question 9

When is a contrast CT indicated in renal cysts

Answer 9

To identify any enhancement of the cysts - this increases the risk of being malignant

Question 10

What is an angiomyolopoma made up of

Answer 10

Blood vessels
fat
muscle

Question 11

What is Wunderlich’s syndrome

Answer 11

The risk of spontaneous haemorrhage - massive retroperitoneal bleeding that can be life threatening
Caused by an angiomyolipoma

Question 12

Why might a fat poor angiomyolipoma need a biopsy and why is this a risky procedure

Answer 12

There is a risk of the tumour being a renal cell carcinoma - biopsy increases the risk of haemorrhage

Question 13

What would be seen on CT in a oncocytoma

Answer 13

A central scar that goes out the way - necrosis in the centre of the tumour

Question 14

What is a main feature that can be used to distinguish the difference between an oncocytoma and a renal cell cancer

Answer 14

Cancer has the ability to recruit new blood supply

Oncocytoma is benign and does not have this ability

Question 15

What is the classic triad seen in the presentation of RCC

Answer 15

Loin pain
renal mass
haematuria

However, most are incidental findings on CT

Question 16

Patients with Paraneoplastic syndromes commonly have what

Answer 16

Weight loss
anaemia
Hypertension
Hypercalcaemia

Question 17

Who and at what age is most likely to develop RCC

Answer 17

Male: female - 2:1

65-75 years of age

Question 18

What are the two main forms of renal cell carcinoma

Answer 18

Adenocarcinoma of the proximal convoluted tubule

Clear cell, papillary

Question 19

What is the one diagnosis that everyone wants to rule out

Answer 19

Von Hippel-Lindau - genetic problem with major consequences

Question 20

What is the key imaging technique required for a diagnosis of RCC

Answer 20

CT triple phase contrast

Question 21

Why is a biopsy not the gold standard investigation for RCC

Answer 21

high false negative in RCC

Question 22

What is the staging that we use for RCC

Answer 22

Robson staging

Question 23

Where do RCCs metastasise to

Answer 23

Lungs
liver
bone
brain

by haematogenous and lymphatic spread

Question 24

What is the treatment used for RCC

Answer 24

chemotherapy

Question 25

What surgery is used for RCC

Answer 25

Radical nephrectomy or partial nephrectomy | Radiofrequency ablation or cryoablation

Question 26

What are some symptoms of BXO

Answer 26

White patches fissuring bleeding scarring

Question 27

What is the treatment for Balanitis Xerotica Obliterates

Answer 27

Circumcision - can affect urethra and may have to have reconstructive skin graft to replace the glans of the penis in very severe cases

Question 28

What is one of the main issues that can lead to BXO

Answer 28

Long term hygiene problem

Question 29

What is the key feature of a squamous carcinoma in situ of the penis

Answer 29

Red velvety patches

Question 30

What is required for a patient with suspected SCC in situ

Answer 30

Punch biopsy

Question 31

What age of man is more likely to develop an invasive squamous cell carcinoma

Answer 31

Older men - late presentation due to embarrassment

Question 32

What is phimosis

Answer 32

Foreskin that doesn't go back

Question 33

Lymphadenopathy of the penis presents where

Answer 33

Groin

Question 34

What virus can lead to carcinoma of the penis

Answer 34

HPV 16

Question 35

When is the peak incidence of age for carcinoma of the penis

Answer 35

80 years

Question 36

What is the main form of cancer of the penis

Answer 36

Squamous cell cranium (skin)

Question 37

What are the treatment options for carcinoma of the penis

Answer 37

Surgery Radiotherapy Depends on inguinal nodes

Question 38

What are the surgical options for Carcinoma of the penis

Answer 38

Total / partial penectomy | Reconstruction

Question 39

In a total penectomy, where does the urethra open

Answer 39

Behind the scrotum

Question 40

What is an orchidectomy

Answer 40

Surgical removal of one or both testes

Question 41

ITGCN (Intra-tubular germ cell neoplasia) has no malignant potential. True or false

Answer 41

False - it could be a premalignant condition

Question 42

What is the classic presentation of a testicular tumour

Answer 42

Painless, insensitive testicular | stony hard swelling

Question 43

What other investigations should be done for staging a testicular tumour

Answer 43

CXR | CT abdo/ pelvis/ thorax

Question 44

What tumour marker is raised in a pure seminoma

Answer 44

AFP | P for potato

Question 45

What tumour marker is more commonly raised in a teratoma

Answer 45

HCG

Question 46

How should a testicular tumour be removed

Answer 46

Inguinal approach - remove the embryological remnants of the testicle

Question 47

What determines the follow up in a teratoma

Answer 47

The level of differentiation

Question 48

Trophoblastic teratomas always have what raised tumour marker

Answer 48

HCG

Question 49

How do we stage testicular tumours

Answer 49

TNM

Question 50

Testes lie where. | Retro peritoneal or intra-abdominal

Answer 50

Intra-abdominal