Urology Cancer Flashcards
Urological cancers
Renal cancer - RCC, TCC Bladder - TCC, Adenocarcinoma, SSC Prostate - Adenocarcinoma Ureters - TCC Penile - SSC Testicular - germ cell or non germ cell
Dipstick values
Leukocytes - inflammation in the urinary tract Nitrites - bacterial infection Protein - renal damage RBC Glucose - diabetes pH - specific stones
False positives for haematuria
Myoglobin
Exercise
Menses
False negative haematuria
Vitamin C
History for haematuria
Duration
How dark is the urine
Clots
LUTS
Examination for haematuria
Abdominal exam
Male:
- external genitalia
- DRE
Investigations for haematuria
Bloods - FBC, CRP, U+Es Urine culture Urine dipstick Flexible cystoscopy If positive - cystoscopy and biopsy USS KUB or CT Urogram
CT urogram
Pre contrast CT - stones
Wait
Post contrast CT - best to view the upper tract TCC
Types of renal cell cancer
Clear cell cancer Papillary Chromophobe - rarely metastasises Collecting - aggressive and rare Medullary - aggressive and rare
Risk factor for clear cell carcinoma
Von Hippel Lindau
Von Hippel Lindau syndrome
Tumour suppressor gene mutation Autosomal dominant Renal cysts Pancreatic cysts Phaeochromocytoma
Presentation of RCC
Asymptomatic
Haematuria
Loin pain
Palpable mass
Risk factors for RCC
Smoking
Obesity
FHx
Von Hippel Lindau
Paraneoplastic syndromes of RCC
Hypercalcaemia - PTHrP, Vit D
HTN - renin
Polycythaemia - EPO
Anaemia
Pyrexia
Cushing’s
Stauffer’s syndrome - abnormal LFTs
Diagnosis of RCC
USS KUB
CT with contrast - diagnostic and staging
Staging of cysts
Bosniak classification
I - renal cysts
IV - RCC
Management of renal cell carcinoma
Low stage:
- Partial nephrectomy
- laparoscopic radical nephrectomy
- Surveillance
- ablation
Perinephric fat invasion: open radical nephrectomy
Mets:
- open nephrectomy
- resection at other structures
- immunotherapy
Why is upper tract TCC less common
Less common as urine is stored in the bladder so less carcinogen exposure
Investigation of upper tract TCC
Uretoscopy and biopsy
Risk factors for bladder cancer
Aromatic amine exposure - dyes and rubber
Polycyclic hydrocarbons
Smoking
SSC:
Schistosomiasis
Long term catheterisation
Recurrent UTI
Investigations of bladder cancer
Flexible cystoscopy
If +ve - rigid cystoscopy and TURBT (catheterised for 1 day)
Management of bladder cancer
Low risk - cystoscopic surveillance
Intermediate risk - 6x weekly intravesicular mitomycin and surveillance
High risk - BCG regimen and cystectomy
BCG regimen
TB vaccination intravesicular
Stimulates a type IV hypersensitivity reaction against tumour antigens
Patient retains BCG then can void after 1 hour
Management for muscle invasive bladder cancer
Systemic neoadjuvant chemotherapy
Cystectomy
Chemoradiotherapy
Management of metastatic bladder cancer
Palliative chemo only
Management for adenocarcinoma or SSC bladder cancer
Cystectomy
Male cystectomy
Cystoprostatectomy + lymph node dissection
Female cystectomy
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
Types of bladder replacement
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
Prostate cancer risk factors
70 + yo
FHx
BRCA2, APC1
Afro Caribbean
(No risk with vasectomy)
Presentation of prostate cancer
LUTS
Bone pain
Weight loss
PSA screening
If patient requests
Problems with PSA screening
Not specific
Not sensitive
Investigations for prostate cancer
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
Gleason grading
Takes 2 most common grades
Low grade - 6 and below
Intermediate grade - 3 + 4
High grade - 4 + 3 and 7+
Management of prostate cancer
Active surveillance
Watchful waiting
Radical prostatectomy
External beam radiotherapy + hormones
Brachytherapy
Dexamethasone
Hormone treatment
Active surveillance
- if low risk and young
- monitor PSA
- if changes, aim is radical treatment
Watchful waiting
Older patients with co - morbidities
Monitoring with PSA
If changes, palliative treatment
Hormone treatment for prostate cancer
Chemotherapy - first 14 days
LHRH analogue injection - may see initial rise
LHRH antagonist - risk of anaphylaxis
Bicalutamide - T cell receptor
Testicular cancer presentation
Lump - solid and attached to testis
Systemic features if mets
Investigations for testicular cancer
USS
CT CAP staging
Bloods - tumour markers
Tumour markers for testicular cancer
Beta HCG, AFP, LDH
Treatment for testicular cancer
Inguinal orchidectomy
Sperm banking
High volume metastatic - chemotherapy
Retroperitoneal lymph node dissection after chemo - NSGCT
Radiotherapy for lymph nodes - seminoma
Lymph node drainage or the testis, penis and scrotum
Testis - para - aortic lymph nodes
Scrotum and penis - superficial inguinal lymph nodes
Types of testicular cancer
Germ cell
- seminoma
- non - seminomatous
Non germ cell tumour
Penile cancer type
Squamous cell carcinoma
Treatment of penile cancer
Excision - circumcision, glansectomy, partial/ total penectomy
Topical 5 - FU
May need inguinal node dissection
Dynamic sentinel node biopsy
