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Year 4 Oncology > Urology > Flashcards

Urology Flashcards

1
Q

Urological cancers

A 
Prostate
Kidney
Bladder
Testis 
Penile
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2
Q

Risk factors for prostate cancer

A

Age
FHx
BRCA2
Ethnicity - black African

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3
Q

Presentation of prostate cancer

A

Asymptomatic - high PSA

LUTS

Suspicious DRE

Bone pain - bone mets

Rare - ejaculatory problems

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4
Q

LUTS

A

Hesitancy
Weak stream
Frequency
Feeling of incomplete urination

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5
Q

Investigations for prostate cancer

A

DRE

PSA - before DRE

MRI prostate/pelvis before biopsy

  • helps decide biopsy technique
  • may not need biopsy

Biopsy

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6
Q

Methods of prostate biopsy

A

TRUS - transrectal ultrasound guided biopsy

Transperineal biopsy

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7
Q

TRUS

A

Targets posterior area of the prostate

Local anaesthetic

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8
Q

Transperineal biopsy

A

Targets whole area of prostate

General anaesthetic

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9
Q

Common causes of raised PSA

A 
Prostate cancer 
Urinary infection 
Prostatitis 
Enlarged prostate - BPH 
Acute urinary retention 
DRE 
Intercourse
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10
Q

Problem with PSA

A

Poor sensitivity - false positives

May have prostate cancer but clinically insignificant

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11
Q

Factors influencing prostate cancer treatment

A 
Age 
DRE
Stage 
PSA - no robotic prostatectomies when > 20 
Biopsy result - Gleason grade 
MRI scan and bone scan - mets
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12
Q

Gleason score and intervention

A

Intervention when 3 + 4 or > 8

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13
Q

Castrate resistant prostate cancer

A

Metastatic prostate cancer

Androgen independent prostate cancer

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14
Q

Metastatic prostate cancer

A

Bone metastasise - osteoblastic therefore sclerotic

Likely if PSA >20

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15
Q

Treatment of prostate cancer

A

Hormones (medical castration) - LHRH agonists

Surgical castration

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16
Q

LHRH agonists

A

LH normally has a pulsatile release

Initial LH flare - more symptomatic therefore give anti-androgen for first 28 days to prevent the flare

Then decreases as downregulated

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17
Q

Palliative options for prostate cancer

A

Single dose radiotherapy

Bisphosphonates - zoledronic acid

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18
Q

Caution with LHRH antagonists

A

Can cause anaphylaxis as similar structure to histamine

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19
Q

Treatment of metastatic castration resistant prostate cancer

A

Add antiandrogen - bicalutamide

Consider prednisolone + docetaxel chemo if good performance status

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20
Q

Locally advanced prostate cancer treatment (no mets)

A

Radical radiotherapy with adjuvant hormones

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21
Q

Treatment of localised prostate cancer

A

Active surveillance
Radical prostatectomy - robotic
Radiotherapy - external beam or brachytherapy

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22
Q

Palliative treatment for localised prostate cancer

A

Deferred hormones - watchful waiting

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23
Q

Prostate screening

A

Opportunistic screening if patients are counselled

24
Q

Problems with prostate cancer screening

A 
Lead time bias 
Length time bias
Overdiagnosis 
Over treatment  - side effects 
Not cost effective
25
Q

Lead time bias

A

Identifying the disease earlier does not affect the prognosis however it seems that there are more years of survival

26
Q

Length time bias

A

Overestimation of survival duration because prostate cancer can be asymptomatic and slowly progressing with a better prognosis.

More aggressive diseases are asymptomatic for a shorter period and are detected after giving symptoms

27
Q

Haematuria types

A

Visible

Non visible - seen on dipstick

28
Q

When to refer haematuria

A

40+ with unexplained visible haematuria

65+ with unexplained non visible haematuria

29
Q

Differentials for haematuria

A

Cancer:

  • RCC
  • TCC
  • Bladder carcinoma
  • Advanced prostate cancer

Other:

  • renal stones
  • UTI
  • glomerulonephritis
  • pyelonephritis/ cystitis
  • BPH
30
Q

Investigations for haematuria in secondary care

A

Radiology - USS
Urine - cytology
Flexible cystoscopy

31
Q

Investigations for haematuria in primary care

A

Bloods - U+Es, albumin/creatinine ratio

MSU - dipstick

32
Q

Presentation of testicular cancer

A

Lump in body of testis

Painless

33
Q

When to refer for 2 ww for testicular cancer

A

Testicular lump

34
Q

What happens in a 2 ww referral

A

Urgent USS of scrotum

Testis tumour markers

35
Q

Testis tumour markers

A

AFP
Beta - hCG
LDH

36
Q

Risk factors for penile cancer

A

Risk factors for STIs

FHx

37
Q

When to suspect penile cancer

A

Excluded STI
Lump/ulcer/lesion is persistent despite treatment
Recurrent balanitis and phimosis

38
Q

Risk factors for bladder cancer

A

Persistent irritation - indwelling catheter, recurrent bladder stones

Schistosomiasis

Overflow incontinence

Occupational exposure

  • rubber or plastic manufacture - arylamines
  • carbon/crude oil - polyaromatic hydrocarbons
  • painters, mechanics, hairdressers

Smoking

Male

White

39
Q

Types of bladder cancer

A

TCC

Squamous cell carcinoma - schistosomiasis

40
Q

Treatment of bladder cancer

A

TURBT - transurethral resection of bladder cancer

Single intravesical instillation of mitomycin

41
Q

Treatment of intermediate/high risk non muscle invasive TCC

A

Check cystoscopy

Intravesical chemotherapy/ immunotherapy

42
Q

Treatment of muscle invasive TCC

A

Potentially curative - neoadjuvant chemotherapy + radical cystectomy or radiotherapy

Palliative chemotherapy or immunotherapy

43
Q

Treatment of metastatic TCC

A

Palliative chemotherapy (cisplatin) or immunotherapy

44
Q

Types of radical cystectomy

A

Ileal conduit

Reconstruction - orthotopic

Women - also remove fallopian tubes

45
Q

Standard treatment of upper urinary tract TCC

A

Nephro - ureterectomy

46
Q

Risk factors for RCC

A

White

Male

Smoking

Obesity

Dialysis

47
Q

Treatment for localised RCC

A

Active surveillance

Excision - radical or partial nephrectomy

48
Q

Radical nephrectomy

A

Removal of kidney, adrenals, peri-nephritic and upper ureter

49
Q

Metastatic RCC treatment

A

Palliative biological targeted therapies - targeting angiogenesis

50
Q

Types of testicular cancer

A

Germ cell tumours - seminoma or teratoma

- usually in men < 45 yo

51
Q

Risk factors of testicular cancer

A

Undescended testis

52
Q

Treatment of testicular cancer

A

Inguinal orchidectomy

53
Q

Which lymph nodes does scrotal cancer spread to

A

Inguinal lymph nodes

54
Q

Which lymph nodes does testicular cancer spread to

A

Para - aortic

55
Q

What type of cancer is penile cancer

A

Squamous cell carcinoma

56
Q

Risk factors for penile cancer

A

Phimosis

HPV 16 and 18

Year 4 Oncology (21 decks)

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