urological pathology Flashcards
what is renal cell carcinoma?
it is cancer of the kidney that arises from the renal tubular epithelium - cancer of the renal collecting ducts
what types of renal cell carcinoma are there?
there are several types - the two most common are clear cell making up 75% of them and papillary making up 10% of them
what is the epidemiology of renal cell carcinoma?
more males than females and those above 60 years old. It predominantly affects those with a PMHx of obesity, smoking, NSAID use and ESRF and on dialysis. Those with a FHx are also affected
what condition is particularly worrying in FHx?
Von Hippel Lindau - caused by gene mutations and inherited
they can also be caused by acquired mutations
what else can influence mutations?
environmental factors such as smoking
what is the basis of renal cell carcinoma?
the mutations accumulate so the hallmarks of cancer accumulate and result in a malignant cell
what are the effects of a tumour?
local primary tumour effects, effects of distant metastases and the paraneoplastic syndromes effects
what are paraneoplastic syndromes effects?
they are the effects that are not related to the local effects of the primary or metastatic tumours and develop as a result of either the cross reactivity between the normal and tumour tissue or the proteins and hormones secreted by the tumour cells
what connects the kidney to the bladder?
the renal pelvis is the attachment site of the ureter to the kidney which then goes to the bladder
what connects the bladder to the penis?
the urethra travels through the prostate and into the penis
what connects the bladder and seminal vesicle to the testis and epididymis?
the vas deferens
what is the appearance of a clear cell and papillary tumour on histological stain?
the clear cell will have many white cells
the papillary will have papillary finger like architecture
what are the hallmarks of cancer?
enabling replicative immortality, avoiding immune destruction, activating metastasis and invasion, tumour promoting inflammation, sustaining proliferative signalling, resisting cell death and evading growth supressors, deregulating cellular energetics, genomic instability and mutation and inducing angiogenesis
what is the 5YSR of renal cell carcinoma?
around 50%
what are the local primary tumour effects of RCC?
heamaturia and abdo pain
what are the effects of distant metastasis in RCC?
lung - shortness of breath
bone - bone pain
what are the PNSs in RCC?
weight loss cancer cachexia
hypertension from renin
polycythaemia from EPO
they are common in RCC
what is a Wilms tumour?
it is also known as a nephroblastoma and is a cancer of the kidney that arises from the nephroblasts which are the cells that develop into the kidney in embryological development
what is the epidemiology of wilms?
children under 5 and 5-10% have genetic syndromes
what are the genetic syndromes associated with WTs?
Beckwith-Weidemann, WAGR and Denys-Drash syndromes
what is an example of a genetic mutation associated with WT?
WT1
what do environmental factors do in WTs?
cause mutations
what are 10% of WTs?
they are bilateral
what is the 5YSR of WTs?
around 90%