urological malignancy Flashcards
hematuria
• Macroscopic
– Visible – preferred term
– Frank
• Microscopic (occult)
– Dipstix
– Urine microscopy
– Non-visible haematuria – preferred term
– Symptomatic versus non-symptomatic
diseases of the kidney
haematuria examination
- Examination
- General examination
- Blood pressure
- Abdomen
- External genitalia
- Rectal examination of the prostate
- Vaginal examination
- Test the urine (dipstix for protein/blood/glucose)
guidlines with haem
haematuria
• Investigations
• Urine microscopy and culture
• Urine cytology
• Renal function (U+E’s, creatinine, eGFR)
• Imaging
– Ultrasound and/ or
– Intravenous urogram and/or
– CT scan
• Cystoscopy
types of bladder cancer
TYPES
Transitional Cell Tumour
Squamous Cell Tumour (Chronic irritation, stones)
Adenocarcinoma (Urachal remnant)
aetiology of bladder cancer
• Dyes, chemicals, aniline compounds.
• Rubber, cable and plastic industry,
hairdresser
• Drugs, Cyclophosphamide
• Smoking
• Schistosomiasis. (SCC)
bladder cancer presentation
Haematuria
Cystitis
Renal failure
Other
spread of cancer
SPREAD:
Direct
Urine-bourne
Lymphatic
Haematogenous
stagin bladder cancer
STAGING
Cystoscopy
Examination under anaesthetic
Histopathology
For muscle invasive disease
CT scan chest/abdomen/pelvis
MRI pelvis
Bone scan
bladdr cancer treatment
SUPERFICIAL
Telescopic Control
Intravesical Chemotherapy
Intravesical Immunotherapy (BCG vaccine)
MUSCLE INVASIVE DISEASE
Surgical Removal following neoadjuvant chemotherapy
Radiotherapy following neoadjuvant chemotherapy
METASTATIC DISEASE
Chemotherapy
Radiotherapy
Palliative Treatment
you can remove the bladder with surgery and attach the urethters to the colon (ileal loop diversion “69” technique
bladder tyoe and treatmenr
Squamous Cell Cancer
Surgical
Treatment
Adenocarcinoma
transitional cell tumour
Transitional Cell Tumour can affect the rest of the
urothelium from kidney to urethral meatus
renal tumours
Adults: Renal cell carcinoma
Angiomyolipoma
Oncocytoma
(Liposarcoma)
(Lipoma)
Children: Wilms’ tumour
(Neuroblastoma)
renal cell CARCINOMAS
Names: Grawitz tumour (Grawitz 1883)
Clear cell carcinoma
Renal cell carcinoma
Adenocarcinoma
renal cel carcinoma
Aetiology:
Few factors identified
Familial
Hereditary (von Hippel-Lindau)
(tuberous sclerosis)
Smoking
renal cell carcinoma present with
Presentation: Haematuria
Loin pain
Abdominal pain
Incidental – USS, CT
Metastases
(Varicocoele)
non met effects of carcinoma
Non-metastatic effects:
Polycythemia (erythropoietin)
Hypercalcaemia (parathyroid hormone)
Hypertension (renin)
Fever
Anaemia
Abnormal LFT’s
Gastrointestinal symptoms (GUT endocrine
hormones)
Amyloid
carcinoma effects
Investigations: FBC
Renal function
IVP
USS
CT scan chest/abdomen
(Bone scan)
where carcinoma mets to`
Routes of spread: Lymphatic
Haematogenous
To: Pulmonary 75%
Skeletal 41%
Brain 13%
Liver 10%
Skin 9%
Other 17%
carcinoma treatment
Treatment: Surgery is the only effective treatment
Radical/partial nephrectomy
VEGF Inhibitors increasing role
(vascular endothelial growth factor)
(Endocrine treatment)
(Immunothreapy)
(Chemotherapy)
(Radiotherapy)
prostate bph sign
Symptoms of an enlarged prostate include
Poor flow
Incomplete bladder emptying
Nocturia
Increased frequency
Most men who have these symptoms do NOT have cancer
bph treament
• No treatment
• Medical therapy with drugs
• Non invasive “surgery”
–Energy sources to destroy tissue
• Surgery
–Transurethral incision/resection
–Laser ablation/resection
–Open surgery
symptoms of prostate cancer
• No symptoms – routine blood test (Prostate Specific Antigen)
• Urinary symptoms (similar to benign enlargement)
• Symptoms from cancer spread
Kidney problems
Bone problems
psa?
• All men have circulating levels of PSA
• Normal ranges?
– <4ng/ml
– <age></age> • Age 45 up to 70
– <3ng/ml in the context of screening
• 11% of men have elevated PSA
– 3-4 of whom will have cancer
• The higher the PSA the greater chance
of prostate cancer being present
symptoms of prostate cancer
• No symptoms – routine blood test (Prostate Specific
Antigen)
• Urinary symptoms (similar to benign enlargement)
• Symptoms from cancer spread
Kidney problems or bone problems
staging of prostate cancer?
• Localised
–Organ confined - T1, T2
– Locally advanced T3
• Metastatic
–Lymph nodes
–Bone
•Staging based on
–Clinical examination
–PSA level
–MRI
–Bone scan
prostate cancer treatment?
• Surveillance Programs/ Watchful Waiting
• Curative treatments of localised prostate cancer
–Surgery
–Radiation treatment +/- hormone therapy
• Symptomatic treatment
–Hormone therapy
–Surgery
–Radiotherapy
–Chemotherapy
–Others
problems with prostte cancer treatment
• Curative treatments of localised prostate cancer
–Surgery
• Surgical complications
• Incontinence
• Impotence
–Radiation treatment +/- hormone therapy
• Acute problems
• Late problems (Bowel/bladder/impotence)
• Second malignancies
• Symptomatic treatment
– Chemotherapy
– Hormone therapy (medical castration)
• Male menopause
