Urology Flashcards
Types of renal tumours
Benign - cysts, angiomyolipoma
Malignant - RCC, SCC, sarcomas, mets
RCC risk factors
Smoking
Obesity
HTN
First degree-relative with RCC (FHx)
Presentation of RCC
50% found incidentally
Haematuria
Pain
Mass in the loin
(All 3 = Beck’s triad)
Para-neoplastic syndrome
Stauffer syndrome - non-metastatic hepatic dysfunction
Subtypes of RCC
Clear cell RCC
Papillary RCC
Chrome phones RCC
How RCC size is staged
T1 - <7cm and organ confined
T2 - >7cm and organ confined
T3 - locally advance (renal vein, IVC invasion)
T4 - beyond Gerota fascia
Investigations of RCC
Urinalysis
Bloods - FBC, U&Es, LFTs
Initiall USS
CTAP
MRI - Urogram
Bone scan for metastasis
Where can urothelial cancers be?
Renal pelvis -> bladder
Urothelial cancers risk factors
Smoking
Exposure to aromatic amines (dye industry)
Occupational exposure (industrial plants, paints, petrol)
Arsenic exposure (in drinking water)
Types of bladder tumours
TCC - by far the most common
SCC
Adenocarcinoma
Sarcoma
Lymphoma
Staging of bladder cancer (T)
Ta - non-invasive (in mucosa)
Tis- ‘flat tumour’
T1 - invades subepithelial connective tissue
T2 - invades muscle
T3 - invades perivesical tissue
T4 - invades prostate, seminal vesicles, uterus, vagina, pelvic/abdominal wall
Staging of bladder cancer (N)
N0 - no node involvement
N1 - invasion of one node in true pelvis
N2 - invasion of multiple nodes in true pelvis
N3 - invasion into common iliac nodes
What nodes are defined to be in the true pelvis?
Hypogastric
Obturator
External iliac
Presacral
Low-risk vs high risk Bladder cancer
Low risk =. Primary, solitary, <3cm, no CIS
High risk = T1 or above, CIS, multiple, recurrent and >3cm
Symptoms of bladder cancer
Haematuria (visible suggests further disease progression)
LUTS
Recurrent UTIs
Investigations for bladder cancer
Urinalysis
Cytology
Molecular marker tests (NMP-22)
USS, CT
Cystoscopy
Treatment for bladder cancer
TURBT for Ta, CIS, and T1
Radical surgery (± neo-adjuvant chemotherapy) for high risk T1 or T2-4
Radical radiotherapy and chemo for T2-3
What can bladder cancer be treated with to prevent recurrence?
Adjuvant chemo
BCG immunotherapy
How to follow up bladder cancer
Cystoscopy
USS, CT
Tumour markers in urine and blood
