Urological malignancy Flashcards
Renal cancers are what type of carcinoma?
Adeno
Bladder cancers are what type of carcinoma?
> 90% transitional cell
Then squamous cell
Then adeno
Renal cancer risk factors
Smoking Male >65 Obesity Hypertension FH
Bladder cancer RFs
Smoking Male >55 Pelvic radiation Chemotherapy Chronic inflammation
Testicular cancer RFs
Cryptorchidism Gonadal dysgenesis FH Personal history- other testis HIV
Penile cancer
Uncircumcised Phimosis HPV Smoking Age HIV
Renal cancer CFs
Haematuria
Loin pain
UTI
Flank mass
Bladder cancer CFs
Haematuria
Dysuriaria
Urinary frequency
Testicular cancer CFs
Change in shape/texture
Pain
Bowen’s dx
DDX for penile cancer
Pre-malignant condition – red, scaly patch of skin and affects squamous cells
Urgent referral for renal cancer
> 45 with
Unexplained visible haematuria or post UTI treatment
Bladder cancer urgent referral
> 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)
Testicular cancer urgent referral
Non-painful enlargement or change in shape/texture
Penile cancer urgent referral
Penile mass or ulcerated lesion, where STI is excluded as a cause or persistent penile lesion after treatment of STI complete
Renal cancer gold standard test
CT abdo-pelvis pre and post IV contrast
Bladder cancer investigation
Cytoscopy (LA)
Biopsy and possible resection
What is TURBT
transurethral resection of bladder tumour
Testicular cancer tumour markers
> ßHCG
AFP
LDH
Localised renal cancer surgery
Surgical management via laparoscopy or open surgery
Small tumours: partial nephrectomy
Large tumours: radical nephrectomy
Metastatic renal cancer treatment
Nephrectomy with immunotherapy (IFN-α OR IL-2 agents)
Biological agents
Sunitinib AND Pazopanib
Metastasectomy
Surgical resection of solitary metastases
Sunitinib AND Pazopanib MOA
Tyrosine kinase inhibitors
Bladder cancer (non-muscle-invasive) management
Carcinoma in situ resected via TURBT OR
Radical Cystectomy
Regular
Surveillance with cytology and cystoscopy
Bladder cancer (muscle-invasive) management
Radical Cystectomy (urine needs to be drained out another way)
Neoadjuvant chemotherapy w cisplatin combination regimen
Regular follow up w CT scans
Radical cystectomy
Removal of the bladder
Urine can be drained out the body by other means:
- Ileal conduit formation: urine drains via urostomy
- Bladder reconstruction: this uses small section of the bowel so urine can drain urethrally or via catheter
Testicular cancer management
Inguinal radical orchidectomy
Removal of testes, spermatic cord and maximal lymphatic system removed
Adjuvant chemotherapy
Cisplatin, etoposide, or bleomycin if required
Radiotherapy
Penile cancer management
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
5 yr survival of bladder, renal, testicular cancer
55, 55, nearly 100
