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Year 2 Clinical > Urological Malignancy > Flashcards

Urological Malignancy Flashcards

1
Q

Types of renal tumours?

A

Malignant:
• Renal cell carcinoma

Benign:
• Oncocytoma
• Angiomyolipomas

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2
Q

Types of penile cancer?

A

SCC

Carcinoma-in-situ

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3
Q

Types of testicular cancer?

A

Seminoma

Teratoma

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4
Q

Mnemonic for the pathology of urological tumours?

A 
Incidence
• Age 
• Sex
• Geographic
• Aetiology
• Predisposing factors
• Macroscopic appearance
• Microscopic appearance
• Spread
• Prognosis

In A Surgeon’s Gown, A Physician May Make Some Progress

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5
Q

Benign renal tumours?

A

Renal cysts

Oncocytoma

Angiomyolipoma

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6
Q

Tumours of the renal pelvis?

A

Transitional cell carcinoma

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7
Q

Tumours of the renal parenchyma?

A

Renal cell carcinoma

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8
Q

Embryonic renal tumours?

A

Nephroblastoma (Wilm’s tumour)

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9
Q

Radiological tests for renal tumours?

A

USS - can differentiate between cysts and solid material

CT scan

MRI scan - can differentiate between tumours and haemorrhage

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10
Q

Occurrence of benign renal cysts?

A

Comprise 70% of benign asymptomatic renal lesions; typically an incidental finding

Can be single OR multiple

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11
Q

Imaging for benign renal cysts?

A

USS and contrast CT scan (can identify if they are simple cysts and whether there is an associated risk, e.g: haemorrhage)

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12
Q

What are angiomyolipomas?

A

Benign tumours of blood vessels, fat and muscles

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13
Q

Imaging for angiomyolipomas?

A

CT scan - hounsfield unit thresholds are used to identify an angiomyolipoma (if <10, there is fat)

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14
Q

Complications of angiomyolipomas?

A

Wunderlich syndrome - spontaneous, non-traumatic renal hemorrhage confined to the subcapsular and perirenal space; it may be 1st presentation of an angiomyolipoma that is ≥6cm in size

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15
Q

Treatment of Wunderlich syndrome?

A

Embolisation

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16
Q

Occurrence of oncocytoma?

A

<10% of renal masses

Some RCCs prove to be an oncocytoma

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17
Q

What are oncocytomas?

A

Often a benign tumour of oncocytes (epithelial cells characterized by an excessive amount of mitochondria)

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18
Q

Imaging of oncocytomas?

A

CT scan - central, stellate scar

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19
Q

Definitive diagnosis of oncocytoma?

A

There is a high false -ve rate at biopsy (as unable to biopsy the entire lesion)

No definitive diagnosis except at NEPHRECTOMY

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20
Q

Classic triad of renal cell carcinomas presentation?

A

Only present in 15%:
• Loin pain
• Renal mass
• Haematuria

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21
Q

Other presentations of renal cell carcinomas?

A

Incidental on imaging

```
Paraneoplastic syndrome, e.g:
• Weight loss
• Anaemia
• Polycythaemia
erythropoietin
• Hypercalcaemia (PTH)
~~~

22
Q

Occurrence of renal cell carcinoma?

A

More common in male (2:1)

Peak incidence at 65-75 years

If multifocal or bilateral, consider VON-HIPPEL LINDAU

23
Q

Types of renal cell carcinoma?

A

Adenocarcinoma of PCT

Clear cell

Papillary

24
Q

Diagnosis of renal cell carcinoma?

A

USS and CT scan

Biopsy (there is a high false -ve rate in RCC)

25
Q

Staging systems for RCC?

A

Robson

TNM staging

26
Q

Metastases from RCC can occur to which areas?

A

LUNGS, liver, bone and brain

27
Q

Surgical options for RCC?

A

Radical nephrectomy -removes the whole kidney within Gerota’s fascia and removes the perinephric fat

Partial nephrectomy (nephron sparing)

Radiofrequency ablation, cryoablation (if small enough)

28
Q

Adjuvant therapy available for RCC?

A

IL-2 (interleukin-2)

INF-α

VEGF/PDGF inhibitors (e.g: Sunitinib) - reduce neovascularisation

29
Q

Measurements available to check the consequences of metastatic disease on the patient’s life?

A

ECOG performance status - assess how disease is progressing, affects ADLs and determine appropriate treatment and prognosis

30
Q

Classifications of penile cancer?

A

Pre-malignant cutaneous lesions:
• Balanitis xerotica obliterans
• Leukoplakia

SCC:
• Carcinoma-in-situ
• Invasive SCC

31
Q

What is balanitis xerotica obliterans?

A

AKA lichenus sclerosus et atrophicus

Affects the prepure and/or glans penis and there may be urethral extension

32
Q

Treatment of balanitis xerotica obliterans?

A

Circumcision

If meatal stenosis has occurred, this requires dilatation

May require glans resurfacing

33
Q

Consequences of balanitis xerotica obliterans?

A

Phimosis is a common consequence

34
Q

Types of carcinoma-in-situ of the penis?

A

If affecting the glans, prepuce or shaft of the penis:
• Erythroplasia of Queyrat

If affecting the remainder of the genitalia:
• Bowen’s disease

35
Q

Presentation of squamous carcinoma-in-situ of the penis?

A

Red, velvety patches

36
Q

Treatment of squamous carcinoma-in-situ of the penis?

A

If prepuce alone is affected, circumcision

Topical 5 fluorouracil

37
Q

Presentation of invasive SCC of the penis?

A 
Often delayed presentation with:
• Red, raised area on the penis
• Fungating mass
• Foul-smelling discharge 
• Phimosis
38
Q

Occurrence of SCC of the penis?

A

Peak incidence at 80 years of age

May be assoc. with HPV type 16 (risk factor)

Circumcision during infancy/childhood MAY provide partial protection against penile cancer, but this is not the case when performed in adulthood

39
Q

Staging of penile carcinoma?

A

TNM staging

40
Q

Treatment of carcinoma of the penis?

A

Surgery

Inguinal nodes (influence prognosis and treatment):
• Imaging, radionuclide sentinel node biopsy
• Inguinal lymphadenectomy

Radiotherapy

41
Q

Surgical options of penile carcinoma?

A

Total/partial penectomy

Reconstruction

Inguinal lymph node sentinel biopsy

42
Q

Classifications of testicular tumours?

A

Germ cell tumours are:
• Seminoma
• Non-seminomatous germ cell tumours (teratoma, embryonal, yolk sac, choriocarcinoma)
• ITGCN (Intratubular Germ Cell Neoplasia)

Secondary tumours:
• Lymphoma
• Leukaemia
• Metastatic spread from elsewhere

43
Q

Presentation of testicular tumours?

A

Painless, insensitive testicular tumours

10% present due to metastases:
• Swollen neck lymph nodes
• Dyspnoea

44
Q

Diagnosis of testicular tumours?

A

USS scan (1st line)

CXR, CT abdomen/thorax (for staging)

Tumour markers:
• α-fetoprotein (AFP)
• Human chorionic gonadotrophin (HCG)
• Lactate dehydrogenase (LDH)

45
Q

Testicular tumours where the different tumours markers are raised?

A

Never raised in a pure seminoma

HCG is raised in:
• 5-10% of pure seminoma
• Up 10 60% of teratoma

LDH - measure of tumour burden (volume)

46
Q

Surgical treatment of testicular tumours?

A

Orchidectomy with high ligation of cord

Prosthesis (patient choice)

47
Q

Cautions with testicular tumour diagnosis and treatment?

A

May do a biopsy of the contralateral testicle (risk of ITGCN)

48
Q

Occurrence of testicular tumours?

A

Peak incidence 2-35 year old

30 x increased risk with undescended testicles

Some cases of bilateral (simultaneously or successively)

49
Q

Pathology of teratoma?

A 
Can be:
• Differentiated
• Intermediate
• Undifferentiated
• Trophoblastic (THESE ALL HAVE ELEVATED HCG)
50
Q

Staging of testicular tumours?

A

TNM staging

AJCC staging

51
Q

Residual mass location with testicular tumours?

A

May require Retroperitoneal Lymph Node Dissection (RPLND) as residual masses may harbour a tumour; these are that:
• 1/3rd fibrous tissue only
• 1/3rd mature teratoma (benign)
• 1/3rd residual tumours

Year 2 Clinical (119 decks)

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