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Met 3b > Urology > Flashcards

Urology Flashcards

1
Q

How are male LUTS assessed?

A

IPSS scoring out of 35 graded mild/moderate/severe

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2
Q

What is the main risk factor for BPH?

A

Age

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3
Q

What are the long term consequences of BPH progression?

A

Likelihood of surgery, risk of retention

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4
Q

What percentage of LUTS are bothersome in men over 65?

A

30 percent

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5
Q

Give examples of voiding LUTS?

A 
Weak/intermittent stream
Straining
Hesitancy
Terminal dribbling
Incomplete emptying
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6
Q

Give examples of storage LUTS?

A

Urgency
Frequency (more than 7 times)
Nocturia (3 times or more)

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7
Q

Give an example of post micturition LUTS?

A

Dribbling

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8
Q

Which medication is given to patients with BPH and ED?

A

Tedafil

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9
Q

What are the first line investigations in LUTS?

A

History and abdominal exam

DRE

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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

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11
Q

Which IPSS score is mild?

A

0-7

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12
Q

Which IPSS score is moderate?

A

8-19

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13
Q

Which IPSS score is severe?

A

20-35

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14
Q

What is the size of a normal prostate?

A

20cc (walnut)

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15
Q

What is the size of a enlarged prostate?

A

30cc (ping pong ball)

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16
Q

What other than BPH can be felt on DRE?

A

Faecal loading/impaction

Rectal tumours

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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

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18
Q

Which investigations are not routinely offered in BPH diagnosis?

A

Cystoscopy
KUB scan
Flow rate measurement
Post residual volume USS

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19
Q

What urine flow rate suggests obstruction?

A

Less than 15ml/s

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20
Q

What is benign bladder obstruction?

A

Bladder impinged by prostate

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21
Q

How can benign bladder obstruction lead to AKI?

A

Retrograde flow of urine

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22
Q

How is benign bladder obstruction treated?

A

Catheter

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23
Q

What is the treatment if voiding symptoms are persistent beyond pharmacological treatment?

A

Intermittent or indwelling catheter

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24
Q

Is bladder training more effective than surgery?

A

No

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25
Q

Which non pharmacological treatment is advised for post micturition dribbling?

A

Urethral milking

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26
Q

How does an alpha blocker work?

A

Blocks alpha 1 adrenergic receptors in the prostate, urethra, bladder neck and detrusor muscle to relax smooth muscle and allow urine to flow

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27
Q

What are the advantages of alpha blockers?

A

Work quickly to relieve LUTS

Well tolerated

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28
Q

What are the disadvantages of using an alpha blocker?

A

No effect on BPH progression/serious complications

Does not alter PSA

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29
Q

What treatment should be given in moderate to severe LUTS?

A

Alpha 1 blocker e.g. tamulosin

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30
Q

When should a 5 alpha reductase inhibitor be given?

A

LUTS + prostate over 30g +/- PSA >1.4ng/ml with a high risk of BPH progression

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31
Q

Give examples of a 5 alpha reductase inhibitor

A

Finasteride

Dutasteride

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32
Q

What is the mechanism of action of 5 alpha reductase inhibitors?

A

Reduction in DHT synthesis so reduces the androgen drive of prostate growth.

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33
Q

When does max shrinkage occur with 5 alpha reductase inhibitors?

A

3-6months

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34
Q

What is the difference between finasteride and dutasteride?

A

Dutasteride inhibits the type I and II isoenzyme but Finasteride only inhibits the type II isoenzyme

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35
Q

What are the side effects of 5 alpha reductase inhibitors?

A

Erectile dysfunction
Retrograde ejaculation
Decreased libido
Ejaculation failure

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36
Q

When should both a 5 alpha reductase inhibitor and alpha 1 blocker be given?

A

Bothersome moderate to severe LUTS

Possible with enlarged prostate or PSA>1.4ng/ml

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37
Q

What additional pharmacological treatment may be beneficial in bladder outlet obstruction?

A

Anticholinergic

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38
Q

What are the risk factors for BPH progression?

A 
Age over 70 with LUTS
IPSS >7 (moderate to severe LUTS)
PSA>1.4ng/ml
Prostate > 30g
Flow rate
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39
Q

How is acute urinary retention treated?

A

Catheterise and give alpha blocker before withdrawing 48 hours later

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40
Q

What treatment should be given in frequent retention?

A

TURP

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41
Q

When can TURP be offered?

A

Frequent retention

Severe voiding symptoms with little response to alternative treatments

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42
Q

How can storage be treated as a last resort?

A

Botox injection into bladder or percutaneous tibial nerve stimulation

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43
Q

How often should alpha blockers be reviewed?

A

After the first 4 to 6 weeks then every 6 to 12 months

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44
Q

When should 5 alpha reductase inhibitors be reviewed?

A

After 3-6m and then every 6-12m

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45
Q

When should anti cholinergic be reviewed?

A

After the first 4-6weeks and then every 6-12m

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46
Q

What makes up the upper urinary tract?

A

Ureters + renal pelvis + kidneys

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47
Q

What makes up the upper urinary tract?

A

Bladder and urethra

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48
Q

What lines the upper urinary tract and bladder?

A

Urothelium (transitional epithelium)

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49
Q

What lines the membranous and spongy urethras?

A

Pseudo stratified columnar epithelial

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50
Q

Which age group has the highest prevalence of UTIs?

A

The elderly

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51
Q

What is the prevalence of UTIs in elderly women?

A

20 to 30 percent

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52
Q

What is the prevalence of UTIs in elderly men?

A

10 percent

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53
Q

What are the 3 routes of infection that cause a UTI?

A
  1. Ascending up the urethra
  2. Lymphatic (IBD, retroperitoneal abscess)
  3. Haematogenous (uncommon)
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54
Q

Explain how bacteria ascend up the urethra?

A

Bacteria colonise the peritoneum from the colon and enter the urethra and ascend upwards

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55
Q

What does bacteria without pyuria suggest?

A

Urine is colonised but there is not active infection

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56
Q

What does pyuria without bacteria suggest?

A

Infection
Carcinoma in situ
TB
Bladder stone

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57
Q

Where do the white blood cells that cause pyuria come from?

A

Urothelium

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58
Q

What is an uncomplicated UTI?

A

Patient has an anatomically normal urinary tract and responds quickly to antibiotics

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59
Q

What is the most common way that patients get an uncomplicated UTI?

A

Hospital acquired (85 percent)

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60
Q

What pathogen is primarily responsible for uncomplicated UTI?

A

E. coli (85 percent)

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61
Q

Which pathogens can lead to UTI?

A 
E. coli
Staph saprophyticus
Strep faecalis
Proteus
Kliebsella
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62
Q

What is a complicated UTI?

A

Underlying anatomical abnormality or a functional abnormality making the patient unresponsive to antibiotics

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63
Q

What percentage of complicated UTI cases were due to E. coli infection?

A

50 percent

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64
Q

What is an isolated UTI?

A

At least 6m between infections

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65
Q

What are recurrent UTIs?

A

More than two infections in 6 months OR more than 3 infections in 12 months

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66
Q

What is a re-infection in UTIs?

A

Infection with a different organism

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67
Q

What is persistent infection in UTIs?

A

Infection with the same organism

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68
Q

Give examples of persistent infections in the urinary tract?

A

Calculi

Chronically infected prostate

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69
Q

What is an unresolved UTI?

A

The UTI does not go away

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70
Q

What can cause an unresolved UTI?

A

Inadequate antibiotics

Bacterial resistance

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71
Q

What is cystitis?

A

Bladder infection/inflammation

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72
Q

What are the symptoms of cystitis?

A

Suprapubic discomfort
Dysuria
Urgency
Small volume voids

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73
Q

What is the first line investigation for a suspected UTI?

A

Midstream urine dip - look for leucocytes and nitrates

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74
Q

Are leucocytes or nitrates more specific to UTI?

A

Nitrates

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75
Q

Are leucocyte or nitrate more sensitive for UTI?

A

Leucocyte

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76
Q

What is the second line investigation for UTI?

A

Urine microscopy and culture (do even if the patient has an unremarkable urine dip)

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77
Q

What are the third line/ further investigations for UTI?

A

Abdominal X ray
USS KUB
IV urogram/ CT urogram

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78
Q

When should a CT urogram be done in favour of IV urogram when investigating UTIs?

A

Anatomical abnormality

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79
Q

What is the first line treatment in uncomplicated UTI?

A

Short course trimethoprim

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80
Q

What is the first line treatment in complicated UTI?

A

Co-amoxiclav (7-10 day course)

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81
Q

What is pyelonephritis?

A

Inflammation of the kidney usually due to bacterial infection

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82
Q

What are the signs and symptoms of pyelonephritis?

A

Flank and loin pain
Nausea and vomiting
Fever and chills
LUTS

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83
Q

What is the first step in investigating pyelonephritis?

A

Urine dip

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84
Q

What bloods are necessary in pyelonephritis?

A

FBC, UandEs and blood culture

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85
Q

Which imagining modalities should be used to investigate pyelonephritis?

A

AXR
Renal USS
CT urogram

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86
Q

Which organism is responsible for 80 percent of pyelonephritis cases?

A

E. coli

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87
Q

What is the first line treatment in pyelonephritis?

A

10 days oral trimethoprim (ciprofloxacin in penicillin allergy)

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88
Q

When should IV antibiotics be used in treating pyelonephritis?

A

If systemically unwell or sepsis

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89
Q

What is a dangerous complication of pyelonephritis?

A

Perinephric abscess

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90
Q

Where do perinephric abscesses arise?

A

Gerota’s fascia (fascia around kidneys and adrenals)

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91
Q

What factors make a perinephric abscess more likely in pyelonephritis?

A

Diabetes

Obstructive calculi

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92
Q

How a perinephric abscess managed?

A

Drain and collection

Give antibiotics until radiological resolution

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93
Q

What is urinary calculus?

A

A solid conglomeration of mineral salts, with or without associated urinary proteins

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94
Q

What the 4 types of stones?

A

Calcium oxalate
Uric acid/urate
Magnesium ammonium sulphate
Cysteine

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95
Q

Which urinary stone is the most common?

A

Calcium oxalate

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96
Q

What is the most common stone composition?

A

80% calcium oxalate + 20% calcium phosphate

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97
Q

If a pure stone is found, what is the most likely aetiology?

A

Metabolic disorder

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98
Q

Which type of stone is completely insoluble?

A

Calcium oxalate

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99
Q

What are the two classifications of calcium oxalate stones?

A
  1. dehydrate (softer)

2. monohydrate (harder)

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100
Q

Which stones do not appear on X ray?

A

Cysteine

Uric acid

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101
Q

What type of stone appears best on X-ray?

A

Calcium oxalate

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102
Q

Which type of stones appear on X-ray?

A

Calcium oxalate
Uric acid (reasonably)
Magnesium ammonium phosphate/ stuvite (poorly)

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103
Q

Which underlying conditions may cause someone to present with calcium phosphate stones?

A 
Hyperparathyroidism
Type 1 distal renal tubular acidosis
Medullary sponge kidney
Urinary stasis
Infection
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104
Q

Are calcium phosphate and stuvite stones usually hard or soft?

A

Soft

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105
Q

Which two stones are often linked?

A

Calcium phosphate and stuvite

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106
Q

Other than calcium phosphate, which other stones are stuvite stones linked to?

A

Staghorn calculi

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107
Q

Which genetic disease can lead to cysteine stones?

A

Cysteinuria

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108
Q

Are cysteine stones hard or soft?

A

Hard

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109
Q

When a cysteine stone is lasered, what phenomena is seen?

A

White smoke with a rotten egg shell smell

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110
Q

Which gas causes a rotten egg smell?

A

H2S

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111
Q

How are cysteine stones typically treated?

A

Medical dissolution therapy

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112
Q

Which type of stone is due to HIV HAART? (so rarely seen these days)

A

Idinavir

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113
Q

Which type of stones do not appear on CT?

A

Idinavir

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114
Q

What unit of measurement is used to predict the success in treating stones?

A

Hounsfield units (analysis of radiodensity on CT)

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115
Q

Explain the free theory of stone formation?

A

Constituents to make stones are in very high concentration and are unopposed in urine

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116
Q

What factors promote the free theory of stone formation?

A

Urine acidity
Urine concentration
Lack of presence of inhibitors

117
Q

Explain the free theory of stone formation

A

Enthalpy of formation is lower on the fixed surfs of urothelium

118
Q

What can increase the fixed theory of stone formation?

A

Randalls plaques - sub endothelial calcium deposits

119
Q

What treatments can be implemented to prevent stones?

A

Alkalisation of stones

Drinking more fluid

120
Q

What is the pathophysiology behind calcium oxalate stones?

A

Randalls plaques

Duct of Bellini plugs - stones form within tubules and stones get stuck on papillary surface

121
Q

What condition may precipitate calcium stones?

A

Hypercalcaemia

122
Q

What diseases can cause hypercalcaemia?

A

Hyperparathyroidism
Sarcoidism
High vitamin D

123
Q

Where can oxalate come from in the body?

A

Gut absorption
Made in the liver
Vitamin C converted into oxalate

124
Q

Which part of the gut absorbs oxalate?

A

The large intestine

125
Q

How does calcium affect oxalate absorption?

A

Calcium binds to oxalate and stops reabsorption which leaders to hyperoxaluria which can cause stones

126
Q

How do bile salts promote oxalate stone formation?

A

Bile salts increase colonic oxalate absorption and perhaps break down bacteria that normally metabolises oxalate

127
Q

Which foods contain a high amount of oxalate?

A

Rhubarb, spinach, beetroot and swiss chard

128
Q

How does chocolate reduce stone formation?

A

Calcium from the milk used in chocolate binds oxalate

129
Q

Why does eating red meat not increase the likelihood of renal stones?

A

Red meat has high rate and high oxalate but it also has high calcium to oppose it

130
Q

Which protein can inhibit stones?

A

Tamm-Horsfall protein

131
Q

What other names can be given to Tamm-Horsfall protein?

A

Osteopontin, uromodulin, citrate, nephrocalcin

132
Q

How does Tamm-Horsfall protein reduce stone formation?

A

It binds to crystalline structures so they don’t bind to urothelium so there is reduced calcium

133
Q

In which conditions does a Tamm-Horsfall protein mutation occur?

A

Familial juvenile hyperaemic nephropathy

Medullary kidney disease type 2

134
Q

How does Tamm-Horsfall protein reduce the chance of UTIs?

A

Reduces the amount of bacteria that attaches to urothelium

135
Q

What is the clinical presentation of uteric colic?

A 
Sudden onset severe loin pain
Pain radiates from groin to loin
Agony
Blood in the urine
Raised creatinine and CRP
Normal FBC
136
Q

Can steric stones get infected?

A

Yes

137
Q

What is the gold standard for diagnosing and assessing renal stones?

A

Ultra low does CT KUB gives a 99 percent diagnosis with defined position, size and hardness

138
Q

What is the first line investigation when investigating uteric stones?

A 
Mid stream urine dip
U and Es
FBC
CRP
Calcium and urate
139
Q

After doing a CT KUB to investigate renal stones, what should be done after?

A

USS KUB to locate the stone

140
Q

How are rate stones diagnosed?

A

Need to use USS KUB as radiolucent

141
Q

How sensitive is USS for picking up urate stones?

A

50 percent

142
Q

In pregnancy or children with stones which imaging modality should be used?

A

USS instead of CT KUB

143
Q

How sensitive is a USS KUB?

A

75 percent

144
Q

What types of stones are commonly missed with USS KUB?

A

Very large or very small stones

145
Q

What can be often mistake for stones when doing a USS KUB?

A

Renal sinus fat

146
Q

What sign is seen on USS KUB when diagnosing a stone?

A

Acoustic shadow

Winkle

147
Q

When should fluids be given in renal cannaliculi?

A

If the patient is vomiting

148
Q

What is the first line therapy with uteric stones?

A

Medical expulsive therapy - give tamulosin to relax the lower ureter
Analgesia

149
Q

What is the second line treatment of uteric stones?

A

Surgical removal

150
Q

When should a MRI scanner be used to image stones instead of a CT?

A

In the second and third trimester of pregnancy

151
Q

Why is a MRI not used with uteric stones?

A

Poor for looking at stones

152
Q

What features of the stone itself may influence management?

A

Size, site and hardness

153
Q

What analgesia may be given when dealing with uteric colic?

A

NSAIDs

Opiates

154
Q

How may NSAIDs affect renal function?

A

Deteriorate it

155
Q

If the stone is located in the proximal urethra what is the first line treatment?

A

Analgesia

Watch and wait and give tamulosin

156
Q

What is the second line treatment if the stone is located in the proximal urethra?

A

Lithotripsy

157
Q

What is the third line treatment if the stone is located in the proximal urethra?

A

Semi-rigid uteroscopy

158
Q

If the stone is in the renal pelvis, what is the first line treatment?

A

Lithotripsy (using ultrasound to destroy the stone)

159
Q

What is the second line treatment if the stone is located in the renal pelvis?

A

Flexible uteroscopy

160
Q

What is the third line treatment if the stone is located in the renal pelvis?

A

Semi rigid uteroscopy

161
Q

What is the fourth line treatment if the stone is located in the renal pelvis?

A

Percutaneous nephrolithotomy

162
Q

What is the first line treatment if the stone is located in the kidney?

A

Watch + wait + analgesia + tamulosin

163
Q

How does treatment for stones in the renal pelvis compare to when the stone is inside the kidney?

A

The first line treatment is watch and wait etc and all subsequent treatments are the same

164
Q

What dietary advice can be given to reduce the risk of stones?

A 
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
Q

Which drugs can be given to prevent stones?

A 
Thiazide diuretics - reduce calciuria
Potassium citrate (poorly tolerated)
Sodium bicarbonate
Allopurinol for rate stones
Penicillamine and thiola for cysteinuria
166
Q

How is stone therapy monitored?

A

24 urine collection
Spot urine for sodium and potassium
Blood urate for allopurinol

167
Q

Which blood test must be done when taking allopurinol for stone therapy?

A

Allopurinol

168
Q

When should metabolic testing be carried out in regards to stones?

A

Multiple attacks
Bilateral
Solitary kidney
Urate/crystal/calcium stones

169
Q

What tests can be done to check for metabolic disease with uteric stones?

A

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
Q

What is the incidence of renal cell carcinoma?

A

7000 cases per year

171
Q

What the risk factors for renal cell carcinoma?

A

Male, smoking, renal failure, on dialysis, hypertension and obesity

172
Q

Which genetic disease gives you a pre disposition to renal cell carcinoma?

A

Von Hippel Landau (VHL)

173
Q

What percentage of those with VHL get renal cell carcinoma?

A

50 percent

174
Q

What type of renal cell carcinoma is linked ti VHL?

A

Clear cell carcinoma (80 percent of the time)

175
Q

Which mutation is seen in clear cell carcinoma?

A

Von Hippel Landau

176
Q

What types of renal carcinoma are there?

A

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
Q

What percentage of renal cell carcinomas are found incidentally?

A

50 percent

178
Q

What is the main presenting symptom of renal cell carcinoma?

A

Macroscopic haematuria

179
Q

What is the classical triad of symptoms for renal cell carcinoma?

A

Macroscopic haematuria
Palpable mass
Flank and loin pain

180
Q

What are the signs of metastasis in renal cell carcinoma?

A

Bone pain
Anorexia
Pyrexia

181
Q

What complications may arise from renal cell carcinoma?

A

Lowe limb oedema
Paraneoplastic syndrome
Acute varicocele

182
Q

What is seen on imaging with renal cell carcinoma?

A

Visible masses

183
Q

What imaging should be done in suspected renal cell carcinoma?

A

USS KUB
Contrast CT abdo
CT chest
Bone scan

184
Q

Which blood tests are essential when investigating renal cell carcinoma?

A

FBC/Us and Es/LFTs/calcium

185
Q

How is localised renal cell carcinoma managed?

A

Radical or partial nephrectomy

186
Q

How is locally advanced renal cell carcinoma managed?

A

Radical nephrectomy with adjuvant chemo

187
Q

How is metastases managed in renal cell carcinoma?

A

Immunotherapy

188
Q

What is the second most common urological cancer?

A

Bladder

189
Q

What is the incidence of bladder cancer?

A

11000 cases per year

190
Q

What are the main risk factors for bladder cancer?

A 
Male
Age 
Smoking
Rubber/dye manufacturing history
Schistomaniasis (can lead to squamous cell carcinoma)
191
Q

Which histological subtype is present in over 90 percent of bladder cancer cases?

A

Transitional cell carcinoma (TCC)

192
Q

What percentage of bladder cancer cases are squamous cell carcinoma?

A

1 to 7 percent

193
Q

What percentage of bladder cancer cases are adenocarcinoma?

A

2 percent

194
Q

What is the main presenting symptom of bladder cancer?

A

Painless macroscopic haematuria

195
Q

What are the symptoms of bladder cancer?

A 
Microscopic haematuria
LUTS
Recurrent UTI
Pain
Lower limb swelling
196
Q

When should haematuria be investigated?

A

Macroscopic OR microscopic on 2-3 dipsticks

197
Q

What is the first line test in haematuria?

A

Renal function with Us and Es

Maybe do a urine microscopy and culture

198
Q

Other than Us and Es, what other investigations should be done in bladder cancer?

A 
Urine dip
USS KUB
Urine cytology
CT urogram
\+/- GN screen
199
Q

What is the management of bladder cancer?

A

Transurethral resection of the bladder tumour (TURBT)

200
Q

In what percentage of cases is TURBT successful?

A

70 percent

201
Q

What treatment should be given as an adjuvant to TURBT to prevent recurrence of bladder cancer?

A

Intravesicle mitomycin C OR Intravesicle BCG vaccine

202
Q

What percentage of bladder cancer reoccurs?

A

30 percent

203
Q

How is staging done of bladder cancer?

A

Based on TURBT and mets

204
Q

How should multiple invasive TCC be managed?

A

Radical cystectomy + urinary diversion or radical external beam therapy

205
Q

How should metastatic bladder cancer be treated?

A

Chemo and radiotherapy

206
Q

Which bladder cancer types have a 10 percent prevalence?

A

Mixed papillary and solid
Carcinoma in situ
Solid

207
Q

What is the most commonly diagnosed male cancer?

A

Prostate cancer

208
Q

What is the lifetime risk of prostate cancer?

A

1 in 12

209
Q

What are the risk factors for prostate cancer?

A

Smoking
Age
Fatty diet

210
Q

Which is main pathological subtype of prostate cancer?

A

Adenocarcinoma

211
Q

What percentage of prostate cancers occur in the peripheral zone?

A

75 percent

212
Q

What percentage of prostate cancers occur in the transitional zone?

A

20 percent

213
Q

What percentage of prostate cancers occur in the central zone?

A

5 percent

214
Q

Is prostatic sarcoma rare?

A

Yes

215
Q

How are the majority of prostate cancer cases discovered?

A

Raised PSA but patient is asymptomatic

216
Q

What is the normal level for PSA?

A

Less than 4ng/ml

217
Q

What are symptoms for prostate cancer?

A 
LUTS
Haematospermia
Perineal discomfort
Lower limb swelling
Anorexia and weight loss
Bone pain and pathological fractures
218
Q

What is PSA?

A

Glycoprotein made by prostatic epithelial

219
Q

How is prostate cancer diagnosed?

A

US guided biopsy

220
Q

How is prostate cancer graded?

A

Gleason grade 1 - 5 based on gland differentiation

221
Q

How is local prostate cancer managed?

A

Radical prostatectomy
Radical external beam radiotherapy
Brachytherapy
Cryotherapy

222
Q

What mechanism of treatment is used for advanced prostate cancer?

A

Androgen deprivation therapy

223
Q

What can practically be done to achieve androgen deprivation?

A

Bilateral orchidectomy
Medical castration with LH-RH antagonist (gosarelin)
Anti androgen monotherapy

224
Q

What is the incidence of testicular cancer?

A

6 in 100,000

225
Q

What are the risk factors for testicular cancer?

A

Caucasian
Undescended testis
HIV
First degree relative

226
Q

What pathology are 90 percent of testicular cancers?

A

Germ cell tumours

227
Q

How are germ cell tumours of the testes defined?

A

Seminoma or non-seminoma

228
Q

Other than germ cell tumours, what other cancer in the testes can be present?

A

Non-germ cell tumours
Lymphoma
Adenomatoid

229
Q

In which cells do sex cord stomal tumours occur?

A

Leydig or sertoli cells

230
Q

What is the most common presentation of testicular cancer?

A

Painless scrotal lump

231
Q

Why may sudden pain be present in testicular cancer?

A

Tumour haemorrhage

232
Q

In what percentage of testicular cancer tumours does haemorrhage occur?

A

5 percent

233
Q

What is the first line test in testicular cancer?

A

Testicular USS

234
Q

What is seen on USS with regard to testicular cancer?

A

Hyperechoic region distorting the normal architecture

Microlithiasis

235
Q

What imaging modality should be used to stage testicular cancer?

A

CT abdo and chest

236
Q

Which tumour markers are used to monitor testicular cancer?

A

AFP
Beta HCG
LDH

237
Q

How is a local seminoma managed?

A

Radical orchidectomy with adjuvant chemo to reduce spread to par aortic lymph nodes

238
Q

How is metastatic seminoma managed ?

A

Radio and chemotherapy

Retroperitoneal lymph node dissection

239
Q

What is the chance of relapse with seminoma?

A

25 percent

240
Q

Which chemotherapy agents are given in metastatic seminoma?

A

Bleomycin + cisplatin + etoposide

241
Q

Which age group is most likely to get prostate cancer?

A

Over 70s

242
Q

What is the role of PSA in prostate cancer?

A

To monitor treatment

243
Q

How is a prostate cancer diagnosis confirmed?

A

DRE + PSA + transurethral biopsy

244
Q

What defines localised prostate cancer?

A

Low gleason score and PSA less than 30

245
Q

When is surgery indicated for prostate cancer?

A

Life expectancy over 15 years
PSA less than 15ng/ml
No comorbidities

246
Q

What treatment is given in androgen resistant prostate cancer?

A

Peripheral adrenal receptor antagonist (bicalutimide)
Can use abiraterone (combo of corticosteroids, oestrogen and CYP17 inhibitors)
Dexamethasone to supress ACTH

247
Q

For how long does oestrogen and steroids help to castrate patients with prostate cancer for?

A

50 percent of them for 4 to 6m

248
Q

What is enzalutamide?

A

Androgen receptor antagonist with 5x affinity that bicalutimide

249
Q

How do androgen receptor antagonists work?

A

Prevents androgen receptor binding to DNA and activator proteins

250
Q

When should enzalutamide be used instead of bicalutimide?

A

In bicalutimide resistance

251
Q

Which type of chemo is given in prostate cancer?

A

Taxanes

252
Q

How to taxanes work?

A

Cytotoxic acting on microtubules

253
Q

Give an example of a taxane?

A

Docetaxel

254
Q

For how long does chemo improve survival in prostate cancer?

A

3 months

255
Q

What are side effects of taxanes?

A

Infection
Tiredness
Hairloss

256
Q

What is carbazetaxel?

A

Modified taxmen to overcome docetaxel resistance

257
Q

When should bisphosphonates be given in prostate cancer?

A

In the event of bone mets

258
Q

Give and example of a RANKL inhibitor?

A

Denosumab

259
Q

When should RANKL inhibitors be given in prostate cancer?

A

Mets

260
Q

What is the main risk factor for penile cancer?

A

HPV infection

261
Q

What type of cancer is penile cancer?

A

Squamous cell carcinoma in the glans

262
Q

Who’s is fully protected from penile cancer?

A

Patients who have had neonatal circumcision

263
Q

What is the primary treatment of penile cancer?

A

Surgical treatment and nodal block dissection

264
Q

What is adjuvant radiotherapy given in penile cancer?

A

To drain inguinal lymph nodes

265
Q

Which chemo regime is given in metastatic penile cancer?

A

Cisplatin + fluorouracil + docetaxel

266
Q

Which type of bladder cancer presents in those with a history of schistomaniasis?

A

Squamous cell carcinoma

267
Q

Is TCC responsive to chemo?

A

Very much so

268
Q

What are the main risk factors for developing TCC?

A

Working with aniline dyes

Smoking

269
Q

How many people get retention with metastatic bladder cancer?

A

8 percent

270
Q

How do germ cell tumours present?

A

Enlarging mass in the testicle

271
Q

In what age groups does testicular cancer normally occur?

A

20 to 40 years

272
Q

What is the role of adjuvant chemo in testicular cancer?

A

To prevent recurrence - does NOT increase survival

273
Q

What are the common sites of mets in testicular cancer?

A

Lymph nodes
Lungs
Liver
Brain

274
Q

Which drug dramatically improves survival in testicular cancer?

A

Cisplatin

275
Q

When is the max result of cisplatin obtained?

A

After 4 doses

276
Q

Which factors of testicular cancer may indicate a poorer survival?

A

High tumour markers
Extragonadal primary sites
Short initial remission

277
Q

What percentage of patients have mets with kidney cancer?

A

50 percent

278
Q

Why is anaemia/polycythaemia often present in renal cancer?

A

Lack of EPO production

279
Q

What percentage of renal cell carcinoma cases are papillary type 2?

A

10 percent

280
Q

Which mutation is seen in papillary type 2 renal cell carcinoma?

A

Fumarate/hydratase

281
Q

Which mutation is seen in papillary type 1 renal cell carcinoma?

A

C Met activation

282
Q

Which mutation is seen in chromophore type renal cell carcinoma?

A

C Kit

283
Q

How is kidney cancer diagnosed?

A

CT

284
Q

What is the treatment for localised kidney cancer?

A

Radical nephrectomy

285
Q

Why is chemotherapy rarely successful in metastatic kidney cancer?

A

Various protein kinases block chemo from working

286
Q

How is metastatic renal cell carcinoma treated?

A

Tyrosine kinase inhibitors e.g. sunitinib, sorafenib
High does IL2
Rapamycin (mTor inhibitor) e.g. evovolinus, sirolinus

287
Q

When can IL2 be given to treat renal cell carcinoma?

A

Fit patient with normal Hb, WCC and platelets

288
Q

What is the normal response rate for IL2 therapy in metastatic renal cell carcinoma?

A

10 percent

Met 3b (5 decks)

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