Urology Flashcards
1
Q
How are male LUTS assessed?
A
IPSS scoring out of 35 graded mild/moderate/severe
2
Q
What is the main risk factor for BPH?
A
Age
3
Q
What are the long term consequences of BPH progression?
A
Likelihood of surgery, risk of retention
4
Q
What percentage of LUTS are bothersome in men over 65?
A
30 percent
5
Q
Give examples of voiding LUTS?
A
Weak/intermittent stream Straining Hesitancy Terminal dribbling Incomplete emptying
6
Q
Give examples of storage LUTS?
A
Urgency
Frequency (more than 7 times)
Nocturia (3 times or more)
7
Q
Give an example of post micturition LUTS?
A
Dribbling
8
Q
Which medication is given to patients with BPH and ED?
A
Tedafil
9
Q
What are the first line investigations in LUTS?
A
History and abdominal exam
DRE
10
Q
What are the second line investigations in LUTS?
A
Urine dip
Frequency volume chart for 3 - 7days
PSA
Maybe biopsy if suspected malignancy and creatinine in suspected AKI/CKD
11
Q
Which IPSS score is mild?
A
0-7
12
Q
Which IPSS score is moderate?
A
8-19
13
Q
Which IPSS score is severe?
A
20-35
14
Q
What is the size of a normal prostate?
A
20cc (walnut)
15
Q
What is the size of a enlarged prostate?
A
30cc (ping pong ball)
16
Q
What other than BPH can be felt on DRE?
A
Faecal loading/impaction
Rectal tumours
17
Q
When should a PSA test be carried out?
A
LUTS suggest bladder outlet obstruction secondary to BPH
Prostate abnormal on DRE
Cancer suspected
18
Q
Which investigations are not routinely offered in BPH diagnosis?
A
Cystoscopy
KUB scan
Flow rate measurement
Post residual volume USS
19
Q
What urine flow rate suggests obstruction?
A
Less than 15ml/s
20
Q
What is benign bladder obstruction?
A
Bladder impinged by prostate
21
Q
How can benign bladder obstruction lead to AKI?
A
Retrograde flow of urine
22
Q
How is benign bladder obstruction treated?
A
Catheter
23
Q
What is the treatment if voiding symptoms are persistent beyond pharmacological treatment?
A
Intermittent or indwelling catheter
24
Q
Is bladder training more effective than surgery?
A
No
25
Which non pharmacological treatment is advised for post micturition dribbling?
Urethral milking
26
How does an alpha blocker work?
Blocks alpha 1 adrenergic receptors in the prostate, urethra, bladder neck and detrusor muscle to relax smooth muscle and allow urine to flow
27
What are the advantages of alpha blockers?
Work quickly to relieve LUTS
| Well tolerated
28
What are the disadvantages of using an alpha blocker?
No effect on BPH progression/serious complications
| Does not alter PSA
29
What treatment should be given in moderate to severe LUTS?
Alpha 1 blocker e.g. tamulosin
30
When should a 5 alpha reductase inhibitor be given?
LUTS + prostate over 30g +/- PSA >1.4ng/ml with a high risk of BPH progression
31
Give examples of a 5 alpha reductase inhibitor
Finasteride
| Dutasteride
32
What is the mechanism of action of 5 alpha reductase inhibitors?
Reduction in DHT synthesis so reduces the androgen drive of prostate growth.
33
When does max shrinkage occur with 5 alpha reductase inhibitors?
3-6months
34
What is the difference between finasteride and dutasteride?
Dutasteride inhibits the type I and II isoenzyme but Finasteride only inhibits the type II isoenzyme
35
What are the side effects of 5 alpha reductase inhibitors?
Erectile dysfunction
Retrograde ejaculation
Decreased libido
Ejaculation failure
36
When should both a 5 alpha reductase inhibitor and alpha 1 blocker be given?
Bothersome moderate to severe LUTS
| Possible with enlarged prostate or PSA>1.4ng/ml
37
What additional pharmacological treatment may be beneficial in bladder outlet obstruction?
Anticholinergic
38
What are the risk factors for BPH progression?
```
Age over 70 with LUTS
IPSS >7 (moderate to severe LUTS)
PSA>1.4ng/ml
Prostate > 30g
Flow rate
```
39
How is acute urinary retention treated?
Catheterise and give alpha blocker before withdrawing 48 hours later
40
What treatment should be given in frequent retention?
TURP
41
When can TURP be offered?
Frequent retention
| Severe voiding symptoms with little response to alternative treatments
42
How can storage be treated as a last resort?
Botox injection into bladder or percutaneous tibial nerve stimulation
43
How often should alpha blockers be reviewed?
After the first 4 to 6 weeks then every 6 to 12 months
44
When should 5 alpha reductase inhibitors be reviewed?
After 3-6m and then every 6-12m
45
When should anti cholinergic be reviewed?
After the first 4-6weeks and then every 6-12m
46
What makes up the upper urinary tract?
Ureters + renal pelvis + kidneys
47
What makes up the upper urinary tract?
Bladder and urethra
48
What lines the upper urinary tract and bladder?
Urothelium (transitional epithelium)
49
What lines the membranous and spongy urethras?
Pseudo stratified columnar epithelial
50
Which age group has the highest prevalence of UTIs?
The elderly
51
What is the prevalence of UTIs in elderly women?
20 to 30 percent
52
What is the prevalence of UTIs in elderly men?
10 percent
53
What are the 3 routes of infection that cause a UTI?
1. Ascending up the urethra
2. Lymphatic (IBD, retroperitoneal abscess)
3. Haematogenous (uncommon)
54
Explain how bacteria ascend up the urethra?
Bacteria colonise the peritoneum from the colon and enter the urethra and ascend upwards
55
What does bacteria without pyuria suggest?
Urine is colonised but there is not active infection
56
What does pyuria without bacteria suggest?
Infection
Carcinoma in situ
TB
Bladder stone
57
Where do the white blood cells that cause pyuria come from?
Urothelium
58
What is an uncomplicated UTI?
Patient has an anatomically normal urinary tract and responds quickly to antibiotics
59
What is the most common way that patients get an uncomplicated UTI?
Hospital acquired (85 percent)
60
What pathogen is primarily responsible for uncomplicated UTI?
E. coli (85 percent)
61
Which pathogens can lead to UTI?
```
E. coli
Staph saprophyticus
Strep faecalis
Proteus
Kliebsella
```
62
What is a complicated UTI?
Underlying anatomical abnormality or a functional abnormality making the patient unresponsive to antibiotics
63
What percentage of complicated UTI cases were due to E. coli infection?
50 percent
64
What is an isolated UTI?
At least 6m between infections
65
What are recurrent UTIs?
More than two infections in 6 months OR more than 3 infections in 12 months
66
What is a re-infection in UTIs?
Infection with a different organism
67
What is persistent infection in UTIs?
Infection with the same organism
68
Give examples of persistent infections in the urinary tract?
Calculi
| Chronically infected prostate
69
What is an unresolved UTI?
The UTI does not go away
70
What can cause an unresolved UTI?
Inadequate antibiotics
| Bacterial resistance
71
What is cystitis?
Bladder infection/inflammation
72
What are the symptoms of cystitis?
Suprapubic discomfort
Dysuria
Urgency
Small volume voids
73
What is the first line investigation for a suspected UTI?
Midstream urine dip - look for leucocytes and nitrates
74
Are leucocytes or nitrates more specific to UTI?
Nitrates
75
Are leucocyte or nitrate more sensitive for UTI?
Leucocyte
76
What is the second line investigation for UTI?
Urine microscopy and culture (do even if the patient has an unremarkable urine dip)
77
What are the third line/ further investigations for UTI?
Abdominal X ray
USS KUB
IV urogram/ CT urogram
78
When should a CT urogram be done in favour of IV urogram when investigating UTIs?
Anatomical abnormality
79
What is the first line treatment in uncomplicated UTI?
Short course trimethoprim
80
What is the first line treatment in complicated UTI?
Co-amoxiclav (7-10 day course)
81
What is pyelonephritis?
Inflammation of the kidney usually due to bacterial infection
82
What are the signs and symptoms of pyelonephritis?
Flank and loin pain
Nausea and vomiting
Fever and chills
LUTS
83
What is the first step in investigating pyelonephritis?
Urine dip
84
What bloods are necessary in pyelonephritis?
FBC, UandEs and blood culture
85
Which imagining modalities should be used to investigate pyelonephritis?
AXR
Renal USS
CT urogram
86
Which organism is responsible for 80 percent of pyelonephritis cases?
E. coli
87
What is the first line treatment in pyelonephritis?
10 days oral trimethoprim (ciprofloxacin in penicillin allergy)
88
When should IV antibiotics be used in treating pyelonephritis?
If systemically unwell or sepsis
89
What is a dangerous complication of pyelonephritis?
Perinephric abscess
90
Where do perinephric abscesses arise?
Gerota's fascia (fascia around kidneys and adrenals)
91
What factors make a perinephric abscess more likely in pyelonephritis?
Diabetes
| Obstructive calculi
92
How a perinephric abscess managed?
Drain and collection
| Give antibiotics until radiological resolution
93
What is urinary calculus?
A solid conglomeration of mineral salts, with or without associated urinary proteins
94
What the 4 types of stones?
Calcium oxalate
Uric acid/urate
Magnesium ammonium sulphate
Cysteine
95
Which urinary stone is the most common?
Calcium oxalate
96
What is the most common stone composition?
80% calcium oxalate + 20% calcium phosphate
97
If a pure stone is found, what is the most likely aetiology?
Metabolic disorder
98
Which type of stone is completely insoluble?
Calcium oxalate
99
What are the two classifications of calcium oxalate stones?
1. dehydrate (softer)
| 2. monohydrate (harder)
100
Which stones do not appear on X ray?
Cysteine
| Uric acid
101
What type of stone appears best on X-ray?
Calcium oxalate
102
Which type of stones appear on X-ray?
Calcium oxalate
Uric acid (reasonably)
Magnesium ammonium phosphate/ stuvite (poorly)
103
Which underlying conditions may cause someone to present with calcium phosphate stones?
```
Hyperparathyroidism
Type 1 distal renal tubular acidosis
Medullary sponge kidney
Urinary stasis
Infection
```
104
Are calcium phosphate and stuvite stones usually hard or soft?
Soft
105
Which two stones are often linked?
Calcium phosphate and stuvite
106
Other than calcium phosphate, which other stones are stuvite stones linked to?
Staghorn calculi
107
Which genetic disease can lead to cysteine stones?
Cysteinuria
108
Are cysteine stones hard or soft?
Hard
109
When a cysteine stone is lasered, what phenomena is seen?
White smoke with a rotten egg shell smell
110
Which gas causes a rotten egg smell?
H2S
111
How are cysteine stones typically treated?
Medical dissolution therapy
112
Which type of stone is due to HIV HAART? (so rarely seen these days)
Idinavir
113
Which type of stones do not appear on CT?
Idinavir
114
What unit of measurement is used to predict the success in treating stones?
Hounsfield units (analysis of radiodensity on CT)
115
Explain the free theory of stone formation?
Constituents to make stones are in very high concentration and are unopposed in urine
116
What factors promote the free theory of stone formation?
Urine acidity
Urine concentration
Lack of presence of inhibitors
117
Explain the free theory of stone formation
Enthalpy of formation is lower on the fixed surfs of urothelium
118
What can increase the fixed theory of stone formation?
Randalls plaques - sub endothelial calcium deposits
119
What treatments can be implemented to prevent stones?
Alkalisation of stones
| Drinking more fluid
120
What is the pathophysiology behind calcium oxalate stones?
Randalls plaques
| Duct of Bellini plugs - stones form within tubules and stones get stuck on papillary surface
121
What condition may precipitate calcium stones?
Hypercalcaemia
122
What diseases can cause hypercalcaemia?
Hyperparathyroidism
Sarcoidism
High vitamin D
123
Where can oxalate come from in the body?
Gut absorption
Made in the liver
Vitamin C converted into oxalate
124
Which part of the gut absorbs oxalate?
The large intestine
125
How does calcium affect oxalate absorption?
Calcium binds to oxalate and stops reabsorption which leaders to hyperoxaluria which can cause stones
126
How do bile salts promote oxalate stone formation?
Bile salts increase colonic oxalate absorption and perhaps break down bacteria that normally metabolises oxalate
127
Which foods contain a high amount of oxalate?
Rhubarb, spinach, beetroot and swiss chard
128
How does chocolate reduce stone formation?
Calcium from the milk used in chocolate binds oxalate
129
Why does eating red meat not increase the likelihood of renal stones?
Red meat has high rate and high oxalate but it also has high calcium to oppose it
130
Which protein can inhibit stones?
Tamm-Horsfall protein
131
What other names can be given to Tamm-Horsfall protein?
Osteopontin, uromodulin, citrate, nephrocalcin
132
How does Tamm-Horsfall protein reduce stone formation?
It binds to crystalline structures so they don't bind to urothelium so there is reduced calcium
133
In which conditions does a Tamm-Horsfall protein mutation occur?
Familial juvenile hyperaemic nephropathy
| Medullary kidney disease type 2
134
How does Tamm-Horsfall protein reduce the chance of UTIs?
Reduces the amount of bacteria that attaches to urothelium
135
What is the clinical presentation of uteric colic?
```
Sudden onset severe loin pain
Pain radiates from groin to loin
Agony
Blood in the urine
Raised creatinine and CRP
Normal FBC
```
136
Can steric stones get infected?
Yes
137
What is the gold standard for diagnosing and assessing renal stones?
Ultra low does CT KUB gives a 99 percent diagnosis with defined position, size and hardness
138
What is the first line investigation when investigating uteric stones?
```
Mid stream urine dip
U and Es
FBC
CRP
Calcium and urate
```
139
After doing a CT KUB to investigate renal stones, what should be done after?
USS KUB to locate the stone
140
How are rate stones diagnosed?
Need to use USS KUB as radiolucent
141
How sensitive is USS for picking up urate stones?
50 percent
142
In pregnancy or children with stones which imaging modality should be used?
USS instead of CT KUB
143
How sensitive is a USS KUB?
75 percent
144
What types of stones are commonly missed with USS KUB?
Very large or very small stones
145
What can be often mistake for stones when doing a USS KUB?
Renal sinus fat
146
What sign is seen on USS KUB when diagnosing a stone?
Acoustic shadow
| Winkle
147
When should fluids be given in renal cannaliculi?
If the patient is vomiting
148
What is the first line therapy with uteric stones?
Medical expulsive therapy - give tamulosin to relax the lower ureter
Analgesia
149
What is the second line treatment of uteric stones?
Surgical removal
150
When should a MRI scanner be used to image stones instead of a CT?
In the second and third trimester of pregnancy
151
Why is a MRI not used with uteric stones?
Poor for looking at stones
152
What features of the stone itself may influence management?
Size, site and hardness
153
What analgesia may be given when dealing with uteric colic?
NSAIDs
| Opiates
154
How may NSAIDs affect renal function?
Deteriorate it
155
If the stone is located in the proximal urethra what is the first line treatment?
Analgesia
| Watch and wait and give tamulosin
156
What is the second line treatment if the stone is located in the proximal urethra?
Lithotripsy
157
What is the third line treatment if the stone is located in the proximal urethra?
Semi-rigid uteroscopy
158
If the stone is in the renal pelvis, what is the first line treatment?
Lithotripsy (using ultrasound to destroy the stone)
159
What is the second line treatment if the stone is located in the renal pelvis?
Flexible uteroscopy
160
What is the third line treatment if the stone is located in the renal pelvis?
Semi rigid uteroscopy
161
What is the fourth line treatment if the stone is located in the renal pelvis?
Percutaneous nephrolithotomy
162
What is the first line treatment if the stone is located in the kidney?
Watch + wait + analgesia + tamulosin
163
How does treatment for stones in the renal pelvis compare to when the stone is inside the kidney?
The first line treatment is watch and wait etc and all subsequent treatments are the same
164
What dietary advice can be given to reduce the risk of stones?
```
Increase fluids to more than 2l/day
Reduce sodium
Increase potassium
Restrict high oxalate food
Reduce animal protein ( promotes urate)
No more than 1000mg vit C
Vit D and calcium supplements
Eat calcium with high oxalate foods`
```
165
Which drugs can be given to prevent stones?
```
Thiazide diuretics - reduce calciuria
Potassium citrate (poorly tolerated)
Sodium bicarbonate
Allopurinol for rate stones
Penicillamine and thiola for cysteinuria
```
166
How is stone therapy monitored?
24 urine collection
Spot urine for sodium and potassium
Blood urate for allopurinol
167
Which blood test must be done when taking allopurinol for stone therapy?
Allopurinol
168
When should metabolic testing be carried out in regards to stones?
Multiple attacks
Bilateral
Solitary kidney
Urate/crystal/calcium stones
169
What tests can be done to check for metabolic disease with uteric stones?
2x 24hr urine collection of calcium oxalate, rate, volume, sodium and citrate
Spot nitroprusside test for cysteine
Blood tests for calcium, rate, bicarb and Us and Es
170
What is the incidence of renal cell carcinoma?
7000 cases per year
171
What the risk factors for renal cell carcinoma?
Male, smoking, renal failure, on dialysis, hypertension and obesity
172
Which genetic disease gives you a pre disposition to renal cell carcinoma?
Von Hippel Landau (VHL)
173
What percentage of those with VHL get renal cell carcinoma?
50 percent
174
What type of renal cell carcinoma is linked ti VHL?
Clear cell carcinoma (80 percent of the time)
175
Which mutation is seen in clear cell carcinoma?
Von Hippel Landau
176
What types of renal carcinoma are there?
Clear cell carcinoma (80 percent)
Papillary type 1 and 2 (10 to 15 percent)
Chromophobe (5 percent)
Collecting duct and medullary cell (5 percent)
177
What percentage of renal cell carcinomas are found incidentally?
50 percent
178
What is the main presenting symptom of renal cell carcinoma?
Macroscopic haematuria
179
What is the classical triad of symptoms for renal cell carcinoma?
Macroscopic haematuria
Palpable mass
Flank and loin pain
180
What are the signs of metastasis in renal cell carcinoma?
Bone pain
Anorexia
Pyrexia
181
What complications may arise from renal cell carcinoma?
Lowe limb oedema
Paraneoplastic syndrome
Acute varicocele
182
What is seen on imaging with renal cell carcinoma?
Visible masses
183
What imaging should be done in suspected renal cell carcinoma?
USS KUB
Contrast CT abdo
CT chest
Bone scan
184
Which blood tests are essential when investigating renal cell carcinoma?
FBC/Us and Es/LFTs/calcium
185
How is localised renal cell carcinoma managed?
Radical or partial nephrectomy
186
How is locally advanced renal cell carcinoma managed?
Radical nephrectomy with adjuvant chemo
187
How is metastases managed in renal cell carcinoma?
Immunotherapy
188
What is the second most common urological cancer?
Bladder
189
What is the incidence of bladder cancer?
11000 cases per year
190
What are the main risk factors for bladder cancer?
```
Male
Age
Smoking
Rubber/dye manufacturing history
Schistomaniasis (can lead to squamous cell carcinoma)
```
191
Which histological subtype is present in over 90 percent of bladder cancer cases?
Transitional cell carcinoma (TCC)
192
What percentage of bladder cancer cases are squamous cell carcinoma?
1 to 7 percent
193
What percentage of bladder cancer cases are adenocarcinoma?
2 percent
194
What is the main presenting symptom of bladder cancer?
Painless macroscopic haematuria
195
What are the symptoms of bladder cancer?
```
Microscopic haematuria
LUTS
Recurrent UTI
Pain
Lower limb swelling
```
196
When should haematuria be investigated?
Macroscopic OR microscopic on 2-3 dipsticks
197
What is the first line test in haematuria?
Renal function with Us and Es
| Maybe do a urine microscopy and culture
198
Other than Us and Es, what other investigations should be done in bladder cancer?
```
Urine dip
USS KUB
Urine cytology
CT urogram
+/- GN screen
```
199
What is the management of bladder cancer?
Transurethral resection of the bladder tumour (TURBT)
200
In what percentage of cases is TURBT successful?
70 percent
201
What treatment should be given as an adjuvant to TURBT to prevent recurrence of bladder cancer?
Intravesicle mitomycin C OR Intravesicle BCG vaccine
202
What percentage of bladder cancer reoccurs?
30 percent
203
How is staging done of bladder cancer?
Based on TURBT and mets
204
How should multiple invasive TCC be managed?
Radical cystectomy + urinary diversion or radical external beam therapy
205
How should metastatic bladder cancer be treated?
Chemo and radiotherapy
206
Which bladder cancer types have a 10 percent prevalence?
Mixed papillary and solid
Carcinoma in situ
Solid
207
What is the most commonly diagnosed male cancer?
Prostate cancer
208
What is the lifetime risk of prostate cancer?
1 in 12
209
What are the risk factors for prostate cancer?
Smoking
Age
Fatty diet
210
Which is main pathological subtype of prostate cancer?
Adenocarcinoma
211
What percentage of prostate cancers occur in the peripheral zone?
75 percent
212
What percentage of prostate cancers occur in the transitional zone?
20 percent
213
What percentage of prostate cancers occur in the central zone?
5 percent
214
Is prostatic sarcoma rare?
Yes
215
How are the majority of prostate cancer cases discovered?
Raised PSA but patient is asymptomatic
216
What is the normal level for PSA?
Less than 4ng/ml
217
What are symptoms for prostate cancer?
```
LUTS
Haematospermia
Perineal discomfort
Lower limb swelling
Anorexia and weight loss
Bone pain and pathological fractures
```
218
What is PSA?
Glycoprotein made by prostatic epithelial
219
How is prostate cancer diagnosed?
US guided biopsy
220
How is prostate cancer graded?
Gleason grade 1 - 5 based on gland differentiation
221
How is local prostate cancer managed?
Radical prostatectomy
Radical external beam radiotherapy
Brachytherapy
Cryotherapy
222
What mechanism of treatment is used for advanced prostate cancer?
Androgen deprivation therapy
223
What can practically be done to achieve androgen deprivation?
Bilateral orchidectomy
Medical castration with LH-RH antagonist (gosarelin)
Anti androgen monotherapy
224
What is the incidence of testicular cancer?
6 in 100,000
225
What are the risk factors for testicular cancer?
Caucasian
Undescended testis
HIV
First degree relative
226
What pathology are 90 percent of testicular cancers?
Germ cell tumours
227
How are germ cell tumours of the testes defined?
Seminoma or non-seminoma
228
Other than germ cell tumours, what other cancer in the testes can be present?
Non-germ cell tumours
Lymphoma
Adenomatoid
229
In which cells do sex cord stomal tumours occur?
Leydig or sertoli cells
230
What is the most common presentation of testicular cancer?
Painless scrotal lump
231
Why may sudden pain be present in testicular cancer?
Tumour haemorrhage
232
In what percentage of testicular cancer tumours does haemorrhage occur?
5 percent
233
What is the first line test in testicular cancer?
Testicular USS
234
What is seen on USS with regard to testicular cancer?
Hyperechoic region distorting the normal architecture
| Microlithiasis
235
What imaging modality should be used to stage testicular cancer?
CT abdo and chest
236
Which tumour markers are used to monitor testicular cancer?
AFP
Beta HCG
LDH
237
How is a local seminoma managed?
Radical orchidectomy with adjuvant chemo to reduce spread to par aortic lymph nodes
238
How is metastatic seminoma managed ?
Radio and chemotherapy
| Retroperitoneal lymph node dissection
239
What is the chance of relapse with seminoma?
25 percent
240
Which chemotherapy agents are given in metastatic seminoma?
Bleomycin + cisplatin + etoposide
241
Which age group is most likely to get prostate cancer?
Over 70s
242
What is the role of PSA in prostate cancer?
To monitor treatment
243
How is a prostate cancer diagnosis confirmed?
DRE + PSA + transurethral biopsy
244
What defines localised prostate cancer?
Low gleason score and PSA less than 30
245
When is surgery indicated for prostate cancer?
Life expectancy over 15 years
PSA less than 15ng/ml
No comorbidities
246
What treatment is given in androgen resistant prostate cancer?
Peripheral adrenal receptor antagonist (bicalutimide)
Can use abiraterone (combo of corticosteroids, oestrogen and CYP17 inhibitors)
Dexamethasone to supress ACTH
247
For how long does oestrogen and steroids help to castrate patients with prostate cancer for?
50 percent of them for 4 to 6m
248
What is enzalutamide?
Androgen receptor antagonist with 5x affinity that bicalutimide
249
How do androgen receptor antagonists work?
Prevents androgen receptor binding to DNA and activator proteins
250
When should enzalutamide be used instead of bicalutimide?
In bicalutimide resistance
251
Which type of chemo is given in prostate cancer?
Taxanes
252
How to taxanes work?
Cytotoxic acting on microtubules
253
Give an example of a taxane?
Docetaxel
254
For how long does chemo improve survival in prostate cancer?
3 months
255
What are side effects of taxanes?
Infection
Tiredness
Hairloss
256
What is carbazetaxel?
Modified taxmen to overcome docetaxel resistance
257
When should bisphosphonates be given in prostate cancer?
In the event of bone mets
258
Give and example of a RANKL inhibitor?
Denosumab
259
When should RANKL inhibitors be given in prostate cancer?
Mets
260
What is the main risk factor for penile cancer?
HPV infection
261
What type of cancer is penile cancer?
Squamous cell carcinoma in the glans
262
Who's is fully protected from penile cancer?
Patients who have had neonatal circumcision
263
What is the primary treatment of penile cancer?
Surgical treatment and nodal block dissection
264
What is adjuvant radiotherapy given in penile cancer?
To drain inguinal lymph nodes
265
Which chemo regime is given in metastatic penile cancer?
Cisplatin + fluorouracil + docetaxel
266
Which type of bladder cancer presents in those with a history of schistomaniasis?
Squamous cell carcinoma
267
Is TCC responsive to chemo?
Very much so
268
What are the main risk factors for developing TCC?
Working with aniline dyes
| Smoking
269
How many people get retention with metastatic bladder cancer?
8 percent
270
How do germ cell tumours present?
Enlarging mass in the testicle
271
In what age groups does testicular cancer normally occur?
20 to 40 years
272
What is the role of adjuvant chemo in testicular cancer?
To prevent recurrence - does NOT increase survival
273
What are the common sites of mets in testicular cancer?
Lymph nodes
Lungs
Liver
Brain
274
Which drug dramatically improves survival in testicular cancer?
Cisplatin
275
When is the max result of cisplatin obtained?
After 4 doses
276
Which factors of testicular cancer may indicate a poorer survival?
High tumour markers
Extragonadal primary sites
Short initial remission
277
What percentage of patients have mets with kidney cancer?
50 percent
278
Why is anaemia/polycythaemia often present in renal cancer?
Lack of EPO production
279
What percentage of renal cell carcinoma cases are papillary type 2?
10 percent
280
Which mutation is seen in papillary type 2 renal cell carcinoma?
Fumarate/hydratase
281
Which mutation is seen in papillary type 1 renal cell carcinoma?
C Met activation
282
Which mutation is seen in chromophore type renal cell carcinoma?
C Kit
283
How is kidney cancer diagnosed?
CT
284
What is the treatment for localised kidney cancer?
Radical nephrectomy
285
Why is chemotherapy rarely successful in metastatic kidney cancer?
Various protein kinases block chemo from working
286
How is metastatic renal cell carcinoma treated?
Tyrosine kinase inhibitors e.g. sunitinib, sorafenib
High does IL2
Rapamycin (mTor inhibitor) e.g. evovolinus, sirolinus
287
When can IL2 be given to treat renal cell carcinoma?
Fit patient with normal Hb, WCC and platelets
288
What is the normal response rate for IL2 therapy in metastatic renal cell carcinoma?
10 percent
