Urological malignancy

Question 1

Renal cancers are what type of carcinoma?

Answer 1

Adeno

Question 2

Bladder cancers are what type of carcinoma?

Answer 2

> 90% transitional cell
Then squamous cell
Then adeno

Question 3

Renal cancer risk factors

Answer 3

Smoking
Male
>65
Obesity
Hypertension
FH

Question 4

Bladder cancer RFs

Answer 4

Smoking
Male
>55
Pelvic radiation
Chemotherapy
Chronic inflammation

Question 5

Testicular cancer RFs

Answer 5

Cryptorchidism 
Gonadal dysgenesis
FH
Personal history- other testis
HIV

Question 6

Penile cancer

Answer 6

Uncircumcised
Phimosis
HPV
Smoking
Age
HIV

Question 7

Renal cancer CFs

Answer 7

Haematuria
Loin pain
UTI
Flank mass

Question 8

Bladder cancer CFs

Answer 8

Haematuria
Dysuriaria
Urinary frequency

Question 9

Testicular cancer CFs

Answer 9

Change in shape/texture

Pain

Question 10

Bowen’s dx

Answer 10

DDX for penile cancer

Pre-malignant condition – red, scaly patch of skin and affects squamous cells

Question 11

Urgent referral for renal cancer

Answer 11

> 45 with

Unexplained visible haematuria or post UTI treatment

Question 12

Bladder cancer urgent referral

Answer 12

> 45
Unexplained visible haematuria without UTI OR
Visible haematuria that persists or recurs after successful treatment of UTI

> 60
Unexplained non-visible haematuria AND EITHER
1. Dysuria OR
2. Raised WBC on a blood test

(Non-urgent Referral: 60y or + w recurrent or persistent unexplained UTI)

Question 13

Testicular cancer urgent referral

Answer 13

Non-painful enlargement or change in shape/texture

Question 14

Penile cancer urgent referral

Answer 14

Penile mass or ulcerated lesion, where STI is excluded as a cause or persistent penile lesion after treatment of STI complete

Question 15

Renal cancer gold standard test

Answer 15

CT abdo-pelvis pre and post IV contrast

Question 16

Bladder cancer investigation

Answer 16

Cytoscopy (LA)

Biopsy and possible resection

Question 17

What is TURBT

Answer 17

transurethral resection of bladder tumour

Question 18

Testicular cancer tumour markers

Answer 18

> ßHCG
AFP
LDH

Question 19

Localised renal cancer surgery

Answer 19

Surgical management via laparoscopy or open surgery

Small tumours: partial nephrectomy
Large tumours: radical nephrectomy

Question 20

Metastatic renal cancer treatment

Answer 20

Nephrectomy with immunotherapy (IFN-α OR IL-2 agents)

Biological agents
Sunitinib AND Pazopanib

Metastasectomy
Surgical resection of solitary metastases

Question 21

Sunitinib AND Pazopanib MOA

Answer 21

Tyrosine kinase inhibitors

Question 22

Bladder cancer (non-muscle-invasive) management

Answer 22

Carcinoma in situ resected via TURBT OR
Radical Cystectomy
Regular
Surveillance with cytology and cystoscopy

Question 23

Bladder cancer (muscle-invasive) management

Answer 23

Radical Cystectomy (urine needs to be drained out another way)
Neoadjuvant chemotherapy w cisplatin combination regimen
Regular follow up w CT scans

Question 24

Radical cystectomy

Answer 24

Removal of the bladder

Urine can be drained out the body by other means:

1. Ileal conduit formation: urine drains via urostomy
2. Bladder reconstruction: this uses small section of the bowel so urine can drain urethrally or via catheter

Question 25

Testicular cancer management

Answer 25

Inguinal radical orchidectomy
Removal of testes, spermatic cord and maximal lymphatic system removed

Adjuvant chemotherapy
Cisplatin, etoposide, or bleomycin if required

Radiotherapy

Question 26

Penile cancer management

Answer 26

Cancer non-invasive: imiquimod OR 5-fluorouacil FOLLOWED BY
Repeat biopsy AND
Long term surveillance

Other options:
Laser treatment
To ablate the tumour

Glans resurfacing
Complete removal of glandular epithelium down to the corpus spongiosum, followed by reconstruction with a split skin or buccal mucosa graft

Surgical Management (most cases)
Tumour cells + 5mm margin around must be removed

Question 27

5 yr survival of bladder, renal, testicular cancer

Answer 27

55, 55, nearly 100