Urological Malignancy Flashcards
How can benign renal cysts be imaged?
USS
(maybe contrast CT)
Which symptoms are caused by benign renal cysts?
Generally no symptoms
(very common incidence 1:10)
What is an angiomyolipoma?
A benign process involving a disproportionate amount of blood vessels, fat and muscle
How can an angiomyolipoma be imaged?
CT
What is the main risk of angiomyolipoma?
Haemorrhage and sudden cardiovascular collapse
How is angiomyolipoma treated?
Embolisation if large
(prevents bursting and blood loss)
What is an oncocytoma?
A benign renal tumour
What is the characteristic appearance of an oncocytoma?
Central scar on CT
Why does an oncocytoma develop a central scar?
Not malignant so does not possess angiogenic potential
Centre necroses and scars
How can oncocytoma be diagnosed?
Only at total nephrectomy
Biopy or 99m-Tc-Sestamibi SPECT-CT can indicate
What is the classic triad of symptoms for a renal tumour?
- Loin pain
- Renal mass
- Haematuria
Vast majority are picked up incidentally before the classic triad appears
What are the main paraneoplastic symptoms of renal cell carcinoma?
Weight loss
Anaemia
Hypercalcaemia (produces parathyroid like peptide)
Hypertension
What is the peak incidence for renal cell carcinoma?
65-75
What is a renal cell carcinoma?
Adenocarcinoma of proximal convoluted tubule
In patient who has multifocal renal cell carcinoma or bilateral tumour, what may be the cause?
Von hippel-Lindau
How can renal cell carcinoma be diagnosed?
USS
Triple phase CT
Percutaneous biopsy
Nephrectomy
Renal cell carcinomas are contrast ___________
Renal cell carcinomas are contrast enhancing
What is the staging system used for rena cell carcinoma?
Robson staging
(or TNM)
Where do renal cell carcinomas commonly metastasize?
Lungs (most common)
Liver
Bone
Brain
What is the standard surgery for renal cell carcinoma?
Laparoscopic nephrectomy
What is not removed routinely in a laparoscopic nephrectomy?
Adrenal gland(s)
What is the idea behind partial nephrectomy?
Nephron sparing
Prevents unnecessary drop in GFR
In patients with small masses, or those where the kidneys cannot be removed, what treatment options are there for renal cell carcinoma?
Radiofrequency ablation
Cryotherapy
How are small renal masses diagnosed?
Almost always by incidental imaging
How are small renal masses generally treated?
Biopsy first
Benign - Monitor
Malignant:
- Minimally invasive ablation
- Partial nephrectomy
What do tyrosine kinase inhibitors do for renal cell carcinomas?
Inhibit angiogenesis pathway
What precancerous lesion on the foreskin has white oatches, fissuring, bleeding and scarring
Balantitis xerotica obliterans
What should be done for BXO?
Circumcision
(unless spread further)
Carcinoma of the penis is related to which virus?
HPV (type 16)
Where does carcinoma of the penis spread?
Inguinal nodes
What are the treatment options for penile carcinoma?
Surgery
Radiotherapy and chemotherapy
Inguinal lymphadenopathy (prevents potential for spread)
What are the most common germ cell tumours of the testes?
Seminoma
Non-seminomatous
How do testicular tumours present?
Painless swelling
Which imaging test is the gold standard for testicular tumours?
USS
(Staging for CT, CXR in case of metastasis)
What are the different markers for testicular cancer?
AFP
HCG
LDH
In pure seminoma, which marker is never raised?
AFP
*What are the types of non-seminomatous testicular cancers?
Where can testicular cancers spread?
Lumbar nodes
