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Year 4 Oncology > Urology Cancer > Flashcards

Urology Cancer Flashcards

1
Q

Urological cancers

A 
Renal cancer - RCC, TCC 
Bladder - TCC, Adenocarcinoma, SSC
Prostate - Adenocarcinoma 
Ureters - TCC
Penile - SSC
Testicular - germ cell or non germ cell
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2
Q

Dipstick values

A 
Leukocytes - inflammation in the urinary tract
Nitrites - bacterial infection 
Protein - renal damage 
RBC 
Glucose - diabetes 
pH - specific stones
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3
Q

False positives for haematuria

A

Myoglobin
Exercise
Menses

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4
Q

False negative haematuria

A

Vitamin C

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5
Q

History for haematuria

A

Duration
How dark is the urine
Clots
LUTS

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6
Q

Examination for haematuria

A

Abdominal exam

Male:

  • external genitalia
  • DRE
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7
Q

Investigations for haematuria

A 
Bloods - FBC, CRP, U+Es
Urine culture 
Urine dipstick 
Flexible cystoscopy 
If positive - cystoscopy and biopsy 
USS KUB or CT Urogram
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8
Q

CT urogram

A

Pre contrast CT - stones
Wait
Post contrast CT - best to view the upper tract TCC

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9
Q

Types of renal cell cancer

A 
Clear cell cancer 
Papillary 
Chromophobe - rarely metastasises 
Collecting - aggressive and rare 
Medullary - aggressive and rare
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10
Q

Risk factor for clear cell carcinoma

A

Von Hippel Lindau

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11
Q

Von Hippel Lindau syndrome

A 
Tumour suppressor gene mutation 
Autosomal dominant 
Renal cysts 
Pancreatic cysts 
Phaeochromocytoma
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12
Q

Presentation of RCC

A

Asymptomatic

Haematuria
Loin pain
Palpable mass

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13
Q

Risk factors for RCC

A

Smoking
Obesity
FHx
Von Hippel Lindau

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14
Q

Paraneoplastic syndromes of RCC

A

Hypercalcaemia - PTHrP, Vit D

HTN - renin

Polycythaemia - EPO

Anaemia

Pyrexia

Cushing’s

Stauffer’s syndrome - abnormal LFTs

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15
Q

Diagnosis of RCC

A

USS KUB

CT with contrast - diagnostic and staging

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16
Q

Staging of cysts

A

Bosniak classification

I - renal cysts
IV - RCC

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17
Q

Management of renal cell carcinoma

A

Low stage:

  • Partial nephrectomy
  • laparoscopic radical nephrectomy
  • Surveillance
  • ablation

Perinephric fat invasion: open radical nephrectomy

Mets:

  • open nephrectomy
  • resection at other structures
  • immunotherapy
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18
Q

Why is upper tract TCC less common

A

Less common as urine is stored in the bladder so less carcinogen exposure

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19
Q

Investigation of upper tract TCC

A

Uretoscopy and biopsy

20
Q

Risk factors for bladder cancer

A

Aromatic amine exposure - dyes and rubber
Polycyclic hydrocarbons
Smoking

SSC:
Schistosomiasis
Long term catheterisation
Recurrent UTI

21
Q

Investigations of bladder cancer

A

Flexible cystoscopy

If +ve - rigid cystoscopy and TURBT (catheterised for 1 day)

22
Q

Management of bladder cancer

A

Low risk - cystoscopic surveillance

Intermediate risk - 6x weekly intravesicular mitomycin and surveillance

High risk - BCG regimen and cystectomy

23
Q

BCG regimen

A

TB vaccination intravesicular
Stimulates a type IV hypersensitivity reaction against tumour antigens

Patient retains BCG then can void after 1 hour

24
Q

Management for muscle invasive bladder cancer

A

Systemic neoadjuvant chemotherapy
Cystectomy
Chemoradiotherapy

25
Q

Management of metastatic bladder cancer

A

Palliative chemo only

26
Q

Management for adenocarcinoma or SSC bladder cancer

A

Cystectomy

27
Q

Male cystectomy

A

Cystoprostatectomy + lymph node dissection

28
Q

Female cystectomy

A

Anterior exenteration - Surgery to remove the urethra, lower part of the ureters, uterus, cervix, vagina, and bladder

Can preserve reproductive organs if fertile but risk of spread

+ lymph node dissection

29
Q

Types of bladder replacement

A

Ileal conduit - ureters connected to small bowel and brought out as a stoma

Neobladder - more small bowel is made as bladder and connected to the urethra

Continent cutaneous diversion - pouch from right hemicolon connected to the abdomen, with long term intra-abdominal catheter

30
Q

Prostate cancer risk factors

A

70 + yo
FHx
BRCA2, APC1
Afro Caribbean

(No risk with vasectomy)

31
Q

Presentation of prostate cancer

A

LUTS
Bone pain
Weight loss

32
Q

PSA screening

A

If patient requests

33
Q

Problems with PSA screening

A

Not specific

Not sensitive

34
Q

Investigations for prostate cancer

A

TRUS - trans rectal USS guided biopsy - local anaesthetic

Now more commonly transperineal biopsy with local anaesthetic as less risk of sepsis and better at reaching the posterior prostate

35
Q

Gleason grading

A

Takes 2 most common grades

Low grade - 6 and below
Intermediate grade - 3 + 4
High grade - 4 + 3 and 7+

36
Q

Management of prostate cancer

A

Active surveillance

Watchful waiting

Radical prostatectomy

External beam radiotherapy + hormones

Brachytherapy

Dexamethasone

Hormone treatment

37
Q

Active surveillance

A
  • if low risk and young
  • monitor PSA
  • if changes, aim is radical treatment
38
Q

Watchful waiting

A

Older patients with co - morbidities
Monitoring with PSA
If changes, palliative treatment

39
Q

Hormone treatment for prostate cancer

A

Chemotherapy - first 14 days
LHRH analogue injection - may see initial rise
LHRH antagonist - risk of anaphylaxis
Bicalutamide - T cell receptor

40
Q

Testicular cancer presentation

A

Lump - solid and attached to testis

Systemic features if mets

41
Q

Investigations for testicular cancer

A

USS
CT CAP staging
Bloods - tumour markers

42
Q

Tumour markers for testicular cancer

A

Beta HCG, AFP, LDH

43
Q

Treatment for testicular cancer

A

Inguinal orchidectomy
Sperm banking

High volume metastatic - chemotherapy
Retroperitoneal lymph node dissection after chemo - NSGCT
Radiotherapy for lymph nodes - seminoma

44
Q

Lymph node drainage or the testis, penis and scrotum

A

Testis - para - aortic lymph nodes

Scrotum and penis - superficial inguinal lymph nodes

45
Q

Types of testicular cancer

A

Germ cell

  • seminoma
  • non - seminomatous

Non germ cell tumour

46
Q

Penile cancer type

A

Squamous cell carcinoma

47
Q

Treatment of penile cancer

A

Excision - circumcision, glansectomy, partial/ total penectomy

Topical 5 - FU

May need inguinal node dissection

Dynamic sentinel node biopsy

Year 4 Oncology (21 decks)

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