Urological Malignancy Flashcards
What is the main cancerous kidney tumour
Renal cell carcinoma (clear cell)
What are the two benign renal tumours
Oncocytoma
Angiomyolipoma
What are the two types of penile cancer
Squamous cell carcinoma
Carcinoma in situ
What are the two forms of testicular tumours
Seminoma
Teratoma
Where is the most common location for transitional cell carcinoma to occur
Renal pelvis
Bladder
Where is the most common location for renal cell carcinoma to occur
Renal parenchyma
What is the embryological form of a renal tumour
Nephroblastoma (Wilm’s tumour)
What investigation is good at identifying a fluid filled lesion
US
When is a contrast CT indicated in renal cysts
To identify any enhancement of the cysts - this increases the risk of being malignant
What is an angiomyolopoma made up of
Blood vessels
fat
muscle
What is Wunderlich’s syndrome
The risk of spontaneous haemorrhage - massive retroperitoneal bleeding that can be life threatening
Caused by an angiomyolipoma
Why might a fat poor angiomyolipoma need a biopsy and why is this a risky procedure
There is a risk of the tumour being a renal cell carcinoma - biopsy increases the risk of haemorrhage
What would be seen on CT in a oncocytoma
A central scar that goes out the way - necrosis in the centre of the tumour
What is a main feature that can be used to distinguish the difference between an oncocytoma and a renal cell cancer
Cancer has the ability to recruit new blood supply
Oncocytoma is benign and does not have this ability
What is the classic triad seen in the presentation of RCC
Loin pain
renal mass
haematuria
However, most are incidental findings on CT
Patients with Paraneoplastic syndromes commonly have what
Weight loss
anaemia
Hypertension
Hypercalcaemia
Who and at what age is most likely to develop RCC
Male: female - 2:1
65-75 years of age
What are the two main forms of renal cell carcinoma
Adenocarcinoma of the proximal convoluted tubule
Clear cell, papillary
What is the one diagnosis that everyone wants to rule out
Von Hippel-Lindau - genetic problem with major consequences
What is the key imaging technique required for a diagnosis of RCC
CT triple phase contrast
Why is a biopsy not the gold standard investigation for RCC
high false negative in RCC
What is the staging that we use for RCC
Robson staging
Where do RCCs metastasise to
Lungs
liver
bone
brain
by haematogenous and lymphatic spread
What is the treatment used for RCC
chemotherapy
What surgery is used for RCC
Radical nephrectomy or partial nephrectomy
Radiofrequency ablation or cryoablation
What are some symptoms of BXO
White patches
fissuring
bleeding
scarring
What is the treatment for Balanitis Xerotica Obliterates
Circumcision - can affect urethra and may have to have reconstructive skin graft to replace the glans of the penis in very severe cases
What is one of the main issues that can lead to BXO
Long term hygiene problem
What is the key feature of a squamous carcinoma in situ of the penis
Red velvety patches
What is required for a patient with suspected SCC in situ
Punch biopsy
What age of man is more likely to develop an invasive squamous cell carcinoma
Older men - late presentation due to embarrassment
What is phimosis
Foreskin that doesn’t go back
Lymphadenopathy of the penis presents where
Groin
What virus can lead to carcinoma of the penis
HPV 16
When is the peak incidence of age for carcinoma of the penis
80 years
What is the main form of cancer of the penis
Squamous cell cranium (skin)
What are the treatment options for carcinoma of the penis
Surgery
Radiotherapy
Depends on inguinal nodes
What are the surgical options for Carcinoma of the penis
Total / partial penectomy
Reconstruction
In a total penectomy, where does the urethra open
Behind the scrotum
What is an orchidectomy
Surgical removal of one or both testes
ITGCN (Intra-tubular germ cell neoplasia) has no malignant potential. True or false
False - it could be a premalignant condition
What is the classic presentation of a testicular tumour
Painless, insensitive testicular
stony hard swelling
What other investigations should be done for staging a testicular tumour
CXR
CT abdo/ pelvis/ thorax
What tumour marker is raised in a pure seminoma
AFP
P for potato
What tumour marker is more commonly raised in a teratoma
HCG
How should a testicular tumour be removed
Inguinal approach - remove the embryological remnants of the testicle
What determines the follow up in a teratoma
The level of differentiation
Trophoblastic teratomas always have what raised tumour marker
HCG
How do we stage testicular tumours
TNM
Testes lie where.
Retro peritoneal or intra-abdominal
Intra-abdominal
