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Cancer Care > Urology > Flashcards

Urology Flashcards

1
Q

Prostate Ca creates what kind of bone lesions?

A

Sclerotic (blastic)

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2
Q

How many CaP patients have mets at diagnosis?

A

50%

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3
Q

What mutations are implicated in CaP?

A

BRCA1/2

HPC1/2

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4
Q

What is PSA?

A

Prostate specific antigen

Protease that dissolve prostatic coagulum to make semen thinner

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5
Q

How is CaP graded?

A

Gleason grade 1-10 (6-10)

Take the 2 biggest areas of cancer and grade those then add together

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6
Q

Describe the T staging of CaP

A

1 in 1 lobe
2 involves both lobes
3 involves seminal vesicles
4 extensive, fixed and infiltrating blood vessels

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7
Q

What are the SEs of radical radiotherapy for CaP?

A

Damage to adjacent organs eg, bowel
Chronic proctitis
Incontinence
Impotence

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8
Q

How do we treat locally advanced or met CaP?

A

Orchidectomy
LHRH agonists
+/- anti-androgens flutamide

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9
Q

What is the median survival for met CaP?

A

6-9 months

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10
Q

What is the 10 year survival for localised CaP?

A

80%

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11
Q

What is the male to female ratio of bladder/renal Ca?

A

3:1

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12
Q

What is the peak age of bladder Ca?

A

65 years

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13
Q

What are the risk factors for bladder Ca?

A 
Chronic parasite infection
Dyes and rubber exposure 
Smoking
Chromosome 9 mutations
Overexpression of EGFR
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14
Q

What are the diseases linked to renal cancer?

A

Von Hippel-Lindau Disease

Familial papillary renal carcinoma Syndrome

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15
Q

What is the mutation seen in Familial Papillary Renal carcinoma Syndrome?

A

Mutation to MET oncogene on chromosome 7q31

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16
Q

Where do Renal mets arise from?

A

Lung
Breast
Melanoma
Lymphoma

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17
Q

On diagnosis, what percentage of patients with bladder tumours have invasive disease?

A

30

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18
Q

95% of bladder cancer are what type?

A

Transitional cell carcinomas

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19
Q

Do most renal tumours arise in the cortex or medulla?

A

Cortex

Usually PCT

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20
Q

What hormones can be produced excessively from renal tumours?

A

EPO
PTHrp
Renin

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21
Q

How do most bladder cancers present?

A

Painless Haematuria

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22
Q

Where does RCC met to?

A

Lung
Liver
Bone
Brain

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23
Q

What investigations are required for painless Haematuria?

A

Urinalysis
Urine cytology
Cystoscopy +/- biopsy

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24
Q

Describe the T staging for RCC

A

1 <7cm limited to the kidney
2 >7cm limited to kidney
3 tumour extension but not beyond Gerota’s fascia
4 tumour invasion before Gerota’s fascia

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25
Q

Describe the T staging for bladder cancer

A 
Is - in situ
A - non invasive papillary carcinoma
1 superficial not beyond lamina propria
2 invading muscle layer
3 involving serosal surface of bladder
4 spread to prostate/uterus/pelvic wall
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26
Q

What is the treatment of a superficial bladder cancer?

A

Transurethral resection (TURBT)

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27
Q

What factors increase the relapse rate for bladder cancer?

A

High grade histology
Incomplete resection
Multifocal disease
Carcinoma in situ

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28
Q

If people have superficial bladder cancer but risk factors for relapse then what would we give?

A

Adjuvant BCG therapy

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29
Q

What is the treatment of muscle invasive bladder cancer?

A

TURBT or radical cystectomy or radical radiotherapy

30
Q

What is used to treat bladder mets?

A

Combination chemotherapy: gemcitabine and cisplatin

31
Q

What is the curative option for RCC?

A

Radical nephrectomy

32
Q

What biological therapies are used in RCC?

A

Angiogenesis inhibitors
Everolimus
Temsirolimus
Sunitinib

33
Q

What immunotherapy can be used for RCCs?

A

Interferon

IL 2

34
Q

What is the 5 year survival of superifical bladder cancer?

A

80-90%

35
Q

What is the 5 year survival of invasive bladder cancer?

A

30-40%

36
Q

What is the 5 year survival of RCC?

A

45%

37
Q

Gynaecomastia can be a sign of which testicular tumour types?

A

Sex cord stromal

Germ cell

38
Q

What are sex cord stromal tumours?

A

Tumours derived from the stormal component of ovary/testis. Comprised of granulosa and theca cells and fibrocytes

39
Q

What are the types of germ cell tumours?

A

Teratomas - well encapsulated tumour from all 3 layers

Seminomas - arises from germ cell epithelium of the seminiferous tubules

40
Q

What are the testicular tumour markers?

A

AFP
Beta HCG
LDH

41
Q

What are the risk factors for RCC?

A 
Obesity
Smoking
Inherited diseases
Renal stones
Family history 
Hypertension
Painkillers and diuretics
Dialysis
Male
42
Q

Beta HCG is used as a tumour marker for …

A

Choriocarcinoma

Germ cell tumours

43
Q

List some benign renal tumours

A

Renal cortical adenoma
Metanephric adenoma
Oncocytoma
Angiomyolipoma

44
Q

What is the commonest renal lesion?

A

Benign renal cyst

45
Q

What are the urological red flags?

A 
Haematuria
LUTS
Persistent or recurrent UTIs
Loin pain
Abdominal mass
Painless lump in testis 
Penile ulceration or bleeding
46
Q

What is the pattern of cervical screening?

A

25 - 49 years every 3 years

50-64 years every 5 years

47
Q

Give examples of LHRH agonists

A

Goserelin

Leuprorelin acetate

48
Q

What is the worry with LHRH agonists?

A

They can cause an initial surge in testosterone which can cause the cancer to grow in response therefore must cover the first few weeks of therapy with an anti-androgen

49
Q

What are the side effects of LHRH agonists?

A 
Hot flushes
Decreased libido
Impotence
Fatigue
Osteoporosis
Gynaecosmastia
Muscle loss
50
Q

When would you use LHRH agonists in CaP treatment?

A

Alongside or before radiotherapy

For advanced cancer to keep it under control

51
Q

The apex of the bladder is connected to the umbilicus via the …

A

Median umbilical ligament

52
Q

The median umbilical ligament is a remnant of the …

A

Urachus

53
Q

The bladder receives blood supply from the …

A

Internal iliac vessels

54
Q

Which surface of the testes does the epididymis lie?

A

Posterolateral

55
Q

Where are Sertoli cells found?

A

Lining the walls of the seminiferous tubules

56
Q

Where are leydig cells found?

A

In the testicular interstitial tissue

57
Q

What is the role of Sertoli and leydig cells?

A

Sertoli - Aid maturation of the spermatozoa

Leydig - produce testosterone

58
Q

Describe the vascular supply to the testicles

A

Testicular artery
Artery of vas deferens
Cremasteric artery

59
Q

Where does the lymph fluid of the testes drain to?

A

Lumbar and para-aortic LNs

60
Q

What are the symptoms of prostatitis?

A

Pain passing urine or flow difficulty

Pain/discomfort around testicles, rectum or lower abdomen

61
Q

What is the management of prostatitis?

A

Antibiotics - ciprofloxacin
Pain killers
Tamsulosin

62
Q

What are the risk factors for prostatitis?

A 
UTI
indwelling catheter
Biopsy
STI
HIV
Anal sex
Pelvic injury
63
Q

What is Von Hippel Lindau Disease?

A

Rare, autosomal dominant disease with a mutation in the VHL tumour suppressor gene
Predisposes to growth of benign and cancerous tumours and cysts

64
Q

What lesions are associated with VHL?

A 
Haemangioblastomas
Kidney cysts
RCC
pancreatic neuroendocrine tumours
Phaeochromocytoma
65
Q

Define the AKI staging

A 
1 = creatinine 1.5-2x baseline or UO <0.5 for >6 hrs
2 = creatinine 2-3x baseline or UO <0.5 for >12 hrs
3 = creative 3+ x baseline or UO <0.3 for 12 hrs
66
Q

Describe the CKD staging

A 
1 >90
2 60-90
3a 45-59
3b 30-44
4 15-29
5 <15
67
Q

Which vertebral levels do the kidney lie over?

A

T12 - L3

68
Q

What is the order of kidney casing from deep to superficial?

A

Renal capsule
Perirenal fat
Renal fascia
Pararenal fat

69
Q

Give the order of blood vessels in the kidney

A 
Renal artery
Segmental
Interlobar 
Arcuate 
Interlobular 
Afferent
Glomerulus
Efferent
Peritubular network
70
Q

What do we call the 3 cylinders of erectile tissue in the penis?

A

2 corpora cavernosa

Corpus spongiosum

71
Q

What is the role of bulbospongisus muscles in the penis?

A

Contracts to empty the spongy urethra of any residual urine or semen
Aids maintaining erection

72
Q

What is the role of ischiocavernosus muscles in the penis?

A

Contracts to force blood from the cavernous spaces into the corpus cavernosa to maintain erection

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