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3: surgery > Urology 3: urological cancer > Flashcards

Urology 3: urological cancer Flashcards

1
Q

what is the association between haematuria and urological cancer

A

microscopic: 5% risk
visible: 20% risk

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2
Q

how should the patient be referred if they have haematuria

A

2 week wait to urology
if there are clots (causing an obstruction) urgent admission

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3
Q

what can cause false results for haematuria on urinalysis

A

false + : exercise, menstruation, myoglobin
false - : vit C intake, heavy proteinuria

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4
Q

what travel related infection is linked to urological cancer

A

schistomiasis
linked to bladder squamous cell carcinoma

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5
Q

what imaging can be used to investigate haematuria

A

CT urogram with non-contrast and delayed post-contrast phase
USS
cystostomy +/- biopsy
if they have clots or active bleeding may need wash out in surgery before cystostomy

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6
Q

what medication should be stopped if a patient presents with haematuria

A

anticoagulants

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7
Q

what are the different types of cancer of the urinary tract

A

kidney- RCC, TCC
ureter - TCC
bladder - TCC, SCC, adenocarcinoma
prostate - BPH, adenocarcinoma

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8
Q

describe RCC

A

tumour of the renal parenchyma
clear cell is the most common type and is associated with von-hippel lindau syndrome

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9
Q

what are the types of RCC

A

clear - around 70% of cases
papillary
chromophobe - less aggressive
collecting duct -rare, aggressive
medullar - rare, associated with sickle cell disease, aggressive

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10
Q

presentation of RCC

A

majority are incidental findings
triad (only seen in around 10%): loin pain, palpable mass, haematuria
risk factors: heavy smoking, obesity, FHx

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11
Q

what are paraneoplastic syndromes

A

group of clinical disorders or syndromes associated with malignant disease but not directly linked to the physical effects of the primary or metastatic tumour

HTN, anaemia, polycythemia, pyrexia, hypercalcaemia, cushings, amenorrhoea, staufers syndrome (abnormal LFTs)

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12
Q

what classification is used for renal cysts

A

bosniak
1- benign, simple
2- midly complex (cyst with septation), benign
3 - very likely to be benign but needs follow up
4 - 60% chance of cancer, multiple septations and compartments
5 - definite RCC

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13
Q

what are the management options for RCC which hasn’t metastasised

A

T1a /b- in older or cormobid patients survalience
can also consider ablation, radical nephrectomy or partial nephrectomy

T2a and above: laparoscopic or open radical nephrectomy +/- lymph node dissection

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14
Q

how can RCC with metastatic disease be managed

A

nephrectomy and resection of mets if possible
tyrosine kinase inhibitor +/- cytoreductive nephrectomy (pallative treatment to reduce symptoms and improve chemos effectiveness)
targeted therapties to interfere with VEGF pathway

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15
Q

describe ureteric TCC

A

uncommon
visible haematuria
CT urogram best for imaging
to confirm ureteroscopy +/- biopsy

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16
Q

how would you manage non-metastatic ureteric TCC

A

small low grade tumour - ablation
majority are managed with laparoscopic nephro-ureterctomy

17
Q

what are the different types of bladder cancers and their specific risk factors

A

TCC (80%) - smoking, rubber and dye exposure
SCC (20%) - long term catheters, recurrent UTI, bladder stones, schistosomiasis
adenocarcinoma -rare

18
Q

how can you manage bladder cancers initially

A

TURBT - trans ureteral resection of bladder tumour (can be diagnostic or curative)
T1 can be fully resected but T2 cant due to muscular invasion
if superficial tumour single dose of intravesical mitomycin is given

for more advanced cancer they may be offered 6 weekly mitomycin intilations, cystectomy and BCG regimen

19
Q

how can the BCG regime be used to manage bladder cancer

A

live attenuated mycobacterium bovis
given intravesically to stimulate type 4 hypersensitivity reaction that activates immune cells to tumour antigens
reduces progression

20
Q

side effects of the BCG regime

A

dysuria, frequency, urgency
UTI
haematuria
bladder contracture / ureteric stenosis (rare)
systemic BCGosis (rare)

if it fails then cystectomy

20
Q

side effects of the BCG regime

A

dysuria, frequency, urgency
UTI
haematuria
bladder contracture / ureteric stenosis (rare)
systemic BCGosis (rare)

if it fails then cystectomy

21
Q

how generally are muscle invasive bladder cancers managed

A

RCC: organ confined - neoadjuvent chemo, and cystectomy, then chemoradiotherapy
if metastatic then palliative chemotherapy

SCC/adenoma: likely to be invasive so generally treated with cystectomy

22
Q

what are the different types of radical cystectomy

A

male = cystoprostatectomy
female = anterior exenteration (bladder, uterus, tubes, ovaries and anterior vaginal wall)

both get pelvic lymph node dissection

23
Q

what are some options for urinary diversion after cystectomy

A

ileal conduit - stoma (ureters connected to small bowel)
neobladder - new bladder made of small bowel
continent cutaneous diversion - catherterisable stoma, pouch fashioned from bowel, and patient passes catherter to empty pouch

24
Q

when is a continent diversion contraindicated

A

renal impairment
hepatic impairment
inadequate small bowel
not able to catherterise

25
Q

what are some complications of continent diversions

A

hyperchloraemic metabolic acidosis (small bowel can re-absorb urine)
incontinence
stones (stagnant urine)
mucous
perforation (dont have the sensation of full bladder)
needs emptying every three hours initially

26
Q

risk factors for prostate cancer

A

age - peaks in 70s
family history
genetics (HPC1, BRCA)
ethnic origin (afro-caribbean)

27
Q

how can prostate cancer present

A

often picked up when asymptomatic
can cause LUTS
in advanced disease - bone pain, weight loss

28
Q

when should you do a PSA test

A

patients with LUTs - unless life expectancy <10yrs and benign DRE
avoid in retention/haematuria unless DRE is suggestive of malignancy
bone pain / weight loss and DRE concerning

29
Q

how does PSA change with age

A

increases with age
there isnt a specific PSA value to exclude cancer
if >100 likely to have metastases but there are other causes to raise PSA

30
Q

what is active surveillance and waitful watching for prostate cancer

A

used for low risk disease
monitor PSA/DRE 6 monthly
aim is to avoid unnesessary treatment if the disease doesnt progress

waitfull watching: for older or comorbid patients with non metastatic disease
aim is pallative treatment with hormones if metastatic or symptomatic

31
Q

what are surgical options for prostate cancer

A

curative - radical prostectomy
palliative - billateral nephrostomy (prevents symptom of obstruction)

32
Q

what treatment options are there for prostate cancer with metastatic disease

A

androgen deprivation therapy
- bicalutamide for 28 days
- LNRH analouge injection after 14 days then monthly or longer if stable

early docetaxel chemotherpay

33
Q

describe testicular cancer

A

uncommon
men who are 15-45
majority are germ cell tumours
can also be lymphoma and leydig cell tumour (linked to klinefelters)

34
Q

what are the different types of germ cell tumours

A

non-seminomatous germ cell tumours
seminoma

35
Q

presentation of testicular tumours

A

noticable lump
solid mas inseperable from the testis on clinical exam
can have systemic symptoms if mets
USS to diagnose, CT CAP for staging

36
Q

what are some testis tumour markers

A

AFP - specific for NSGCT
B-HCG - NSGCT
LDH

37
Q

managment of testicular canceer

A

inguinal orchidecotmy with testicular prosthesis
if advanced mets then neoadjuvant chemo
retroperitoneal lymph node disection for NSGCT

38
Q

describe penile cancer

A

very rare
SCC
Excision- circumcision, glansectomy, partial/total penectomy
may need inguinal node dissection

3: surgery (32 decks)

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