Urology cancers Flashcards
Penile cancer
- Risk factors
HPV
- 16, 18
- 6, 8= low risk (Buschke- Lowenstein)
- HPV expression has higher survival rate
Non-circumcised
HIV
Testicular cancer
- Types
Seminoma
- Pure seminoma= commonest single subtype
Non- seminoma germ cell tissue (NSGCT)- most common
- Mixed, teratoma, choriocarcinoma, yolf sac.
Testicular cancer
- Presentation
Younger age (<40)
Lump felt on testicle
- Usually painful
- Hard
Haematospermia
Testicular cancer
- Epidemiology
Younger age (<40)
- Mortalility is higher for older
White> Black, 5:1
Mortality is higher unmarried couples
- As well as in seminoma
Diagnosis of testicular cancer
Clinical examination of testes
Imaging
- USS
- MRI
Microlithiasis
Calcium clusters in testes
Tumour markers for testicular cancer
AFP
- Non-seminoma
Beta-hCG
- 40-60% for NSGCT
1 or 2 markers elevated in NSGCT
30% of seminomas have elevated marker
Pre-operative for testicular cancer
Sperm banking
- Especially if family hasn’t been had
Serum tumour markers
Testicular prosthesis counselling
Contralateral testis biopsy
Radical orchiectomy
- Description
- Approach
Removal of testes
Approach
- Inguinal
- Incision just above inguinal ligament
Spermatic cord located and testes taken out via inguinal region
Post-op evaluation of testicular cancer
Histology of tumour
Staging
- CT (Chest, abdo, pelvis)
Tumour markers
Risk stratification
- Low risk= no vascular invasion
- High risk= vascular invasion
Treatment for NSGCT
- Low risk
- High risk
Low risk
- Surveillance
- Adjuvant chemo
- Nerve sparing RPLND (retroperitoneal lymph node dissection)
High risk
- Ochidectomy, chemo
Treatment for seminoma
Orchidectomy
Early stage
- Adjuvant irradiation
- Surveillance
Later stage
- Adjuvant chemo
Cure rate= >99%
Bladder cancer
- Incidence and sex
Incidence= 1:5000
- Trend has been increasing
- Third prevalent type of cancer
Sex= M>F 4:1
Bladder cancer
- Presentation
Microscopic Haematuria
- Primary symptom
- Painless
Dysuria, urinary frequency/ urgency
Recurrent UTis
Urinary retention
Bladder cancer
- Risk factors
Smoking
Genetic susceptibility
- NAT2
Amine exposure (rubber)
Iatrogenic: radiotherapy, cyclophosphamide, pioglitazone
Renal TCC
Chronic cystitis
Schistosomiasis
M>F
Older age
Grades of bladder cancer
low risk
- Grade 1, 2
- Well/ moderately differentiated
- Papillary easier to visualise
High risk
- Grade 2-3
- Grade 3= poor differentiation
- Often flat, in situ.
invasive
- Mets, nodal involvement
- T2+
Renal tumours
- Types
Renal Cell Carcinoma
- Most common
Transitional cell carcinoma
- 90% of lower UTI tumours but only 10% of renal tumours
Renal cell cancer
- Risk factors
Smoking
obesity
HTN
Dialysis
Genetic
- Hereditary papillary RCC
Renal Cell Carcinoma pathology
Adenocarcinoma
Subtypes
- Clear cell (glycogen)= most common
- Papillary
- Chromophobe
- Collecting duct (least common)
Renal cancer mortality
5 year survival = 54%
Renal cancer presentation
Most cases are incidental findings
Traid
- Haematuria
- Loin pain
- Loin mass
Systemic symptoms
- Anorexia, malaises, weight loss
Hypertension
metastasis: bone pain, haemoptysis, pathological fractures
Paraneoplastic renal cancer presentation
Polycythaemia
- EPO
Hypercalcaemia
- PTHrP
Hypertension
- Renin
Cushing’s
- ACTH
Amyloidosis
Renal cancer imaging
CT is gold standard
- Before and fater contrast
USS
- Sensitive but user-dependent
MRI for contrast allergy/ pregnancy
Treatment of renal cancer
Localised
- Partial nephrectomy= laparoscopic/ robotic
- Cryo-ablation/ RFA (radiofrequency ablation)
Invasive/ large tumour
- Radical nephrectomy= laparoscopic
Renal cancer tumour markers
CK7+
- More positive in chromophobe
CD15+
- More positive in oncoytoma
EpCAM+
- More positive in chromophobe
Bladder cancer pathology
Most common
- Transitional cell carcinoma/ Urothelial
Squamous cell carcinoma
- Associated with schistosomiasis
Adenocarcinoma
Bladder Cancer stages
- Ta/ Tis
- T1
- T2
- T3
- T4
Ta
- Non-invasive papillary carcinoma
Tis
- Carcinoma in situ (flat tumour)
T1
- Tumour invades lamina propria
T2
- Invasion of mucularis propia
T3
- Perivesical invasion
T4
- Invasion of local tissues: i.e uterus, vagina, static stroma, pelvic/abdominal wall
Bladder cancer
- Investigations
Urine dip
- may indicate haematuria
- screen for infection
Cytoscopy
- Low grade tumours are easy to visualise
- High grade are often flat/ in situ, so harder to visualise
Urinalysis
- RBC casts, crenated red cells
Urine cytology
- Low grade tumours often negative
- High grade tumour often positive
Renal and bladder USS
CT abdomen and pelvis
- For staging
Bladder cancer treatment
- Local
- high grade
- Invasive
Local not invaded detrusor
- Complete transurethral resection
- Post op chemo adjunct
High risk, not invading muscle
- Transurethral resection
- Post op Chemo
- BCG immunotherapy
Muscle invasive
- Neoadjuvant chemo
- Cystoprostatectomy
- Pelvic lymphadenopathy
- Post op radiotherapy
N staging for bladder cancer
- N1, 2, 3
N1
- Single LN metastasis in true pelvis
N2
- Muliple LN mets in true pelvis
N3
- Mets in Common iliac lymph node
Cannonball metastases in the lungs is associated with which cancer?
Renal cell carcinoma
Schistosomiasis is associated with developing what malignancy?
Squamous cell carcinoma of the bladder
Indications for urgent cancer referral for haematuria
> 45 + unexplained visible haematuria without UTI or persistent UTI after treatment
> 60 with unexplained non-visible haematuria AND
- dysuria or
- Raised WCC
