Urological Malignancy Flashcards
Types of renal tumours?
Malignant:
• Renal cell carcinoma
Benign:
• Oncocytoma
• Angiomyolipomas
Types of penile cancer?
SCC
Carcinoma-in-situ
Types of testicular cancer?
Seminoma
Teratoma
Mnemonic for the pathology of urological tumours?
Incidence • Age • Sex • Geographic • Aetiology • Predisposing factors • Macroscopic appearance • Microscopic appearance • Spread • Prognosis
In A Surgeon’s Gown, A Physician May Make Some Progress
Benign renal tumours?
Renal cysts
Oncocytoma
Angiomyolipoma
Tumours of the renal pelvis?
Transitional cell carcinoma
Tumours of the renal parenchyma?
Renal cell carcinoma
Embryonic renal tumours?
Nephroblastoma (Wilm’s tumour)
Radiological tests for renal tumours?
USS - can differentiate between cysts and solid material
CT scan
MRI scan - can differentiate between tumours and haemorrhage
Occurrence of benign renal cysts?
Comprise 70% of benign asymptomatic renal lesions; typically an incidental finding
Can be single OR multiple
Imaging for benign renal cysts?
USS and contrast CT scan (can identify if they are simple cysts and whether there is an associated risk, e.g: haemorrhage)
What are angiomyolipomas?
Benign tumours of blood vessels, fat and muscles
Imaging for angiomyolipomas?
CT scan - hounsfield unit thresholds are used to identify an angiomyolipoma (if <10, there is fat)
Complications of angiomyolipomas?
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
Treatment of Wunderlich syndrome?
Embolisation
Occurrence of oncocytoma?
<10% of renal masses
Some RCCs prove to be an oncocytoma
What are oncocytomas?
Often a benign tumour of oncocytes (epithelial cells characterized by an excessive amount of mitochondria)
Imaging of oncocytomas?
CT scan - central, stellate scar
Definitive diagnosis of oncocytoma?
There is a high false -ve rate at biopsy (as unable to biopsy the entire lesion)
No definitive diagnosis except at NEPHRECTOMY
Classic triad of renal cell carcinomas presentation?
Only present in 15%:
• Loin pain
• Renal mass
• Haematuria
Other presentations of renal cell carcinomas?
Incidental on imaging
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Paraneoplastic syndrome, e.g:
• Weight loss
• Anaemia
• Polycythaemia
erythropoietin
• Hypercalcaemia (PTH)
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Occurrence of renal cell carcinoma?
More common in male (2:1)
Peak incidence at 65-75 years
If multifocal or bilateral, consider VON-HIPPEL LINDAU
Types of renal cell carcinoma?
Adenocarcinoma of PCT
Clear cell
Papillary
Diagnosis of renal cell carcinoma?
USS and CT scan
Biopsy (there is a high false -ve rate in RCC)
Staging systems for RCC?
Robson
TNM staging
Metastases from RCC can occur to which areas?
LUNGS, liver, bone and brain
Surgical options for RCC?
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)
Adjuvant therapy available for RCC?
IL-2 (interleukin-2)
INF-α
VEGF/PDGF inhibitors (e.g: Sunitinib) - reduce neovascularisation
Measurements available to check the consequences of metastatic disease on the patient’s life?
ECOG performance status - assess how disease is progressing, affects ADLs and determine appropriate treatment and prognosis
Classifications of penile cancer?
Pre-malignant cutaneous lesions:
• Balanitis xerotica obliterans
• Leukoplakia
SCC:
• Carcinoma-in-situ
• Invasive SCC
What is balanitis xerotica obliterans?
AKA lichenus sclerosus et atrophicus
Affects the prepure and/or glans penis and there may be urethral extension
Treatment of balanitis xerotica obliterans?
Circumcision
If meatal stenosis has occurred, this requires dilatation
May require glans resurfacing
Consequences of balanitis xerotica obliterans?
Phimosis is a common consequence
Types of carcinoma-in-situ of the penis?
If affecting the glans, prepuce or shaft of the penis:
• Erythroplasia of Queyrat
If affecting the remainder of the genitalia:
• Bowen’s disease
Presentation of squamous carcinoma-in-situ of the penis?
Red, velvety patches
Treatment of squamous carcinoma-in-situ of the penis?
If prepuce alone is affected, circumcision
Topical 5 fluorouracil
Presentation of invasive SCC of the penis?
Often delayed presentation with: • Red, raised area on the penis • Fungating mass • Foul-smelling discharge • Phimosis
Occurrence of SCC of the penis?
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
Staging of penile carcinoma?
TNM staging
Treatment of carcinoma of the penis?
Surgery
Inguinal nodes (influence prognosis and treatment):
• Imaging, radionuclide sentinel node biopsy
• Inguinal lymphadenectomy
Radiotherapy
Surgical options of penile carcinoma?
Total/partial penectomy
Reconstruction
Inguinal lymph node sentinel biopsy
Classifications of testicular tumours?
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
Presentation of testicular tumours?
Painless, insensitive testicular tumours
10% present due to metastases:
• Swollen neck lymph nodes
• Dyspnoea
Diagnosis of testicular tumours?
USS scan (1st line)
CXR, CT abdomen/thorax (for staging)
Tumour markers:
• α-fetoprotein (AFP)
• Human chorionic gonadotrophin (HCG)
• Lactate dehydrogenase (LDH)
Testicular tumours where the different tumours markers are raised?
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)
Surgical treatment of testicular tumours?
Orchidectomy with high ligation of cord
Prosthesis (patient choice)
Cautions with testicular tumour diagnosis and treatment?
May do a biopsy of the contralateral testicle (risk of ITGCN)
Occurrence of testicular tumours?
Peak incidence 2-35 year old
30 x increased risk with undescended testicles
Some cases of bilateral (simultaneously or successively)
Pathology of teratoma?
Can be: • Differentiated • Intermediate • Undifferentiated • Trophoblastic (THESE ALL HAVE ELEVATED HCG)
Staging of testicular tumours?
TNM staging
AJCC staging
Residual mass location with testicular tumours?
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
