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304: Urology + Breast > Urology cancers > Flashcards

Urology cancers Flashcards

1
Q

Penile cancer
- Risk factors

A

HPV
- 16, 18
- 6, 8= low risk (Buschke- Lowenstein)
- HPV expression has higher survival rate

Non-circumcised

HIV

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2
Q

Testicular cancer
- Types

A

Seminoma
- Pure seminoma= commonest single subtype

Non- seminoma germ cell tissue (NSGCT)- most common
- Mixed, teratoma, choriocarcinoma, yolf sac.

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3
Q

Testicular cancer
- Presentation

A

Younger age (<40)

Lump felt on testicle
- Usually painful
- Hard

Haematospermia

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4
Q

Testicular cancer
- Epidemiology

A

Younger age (<40)
- Mortalility is higher for older

White> Black, 5:1

Mortality is higher unmarried couples
- As well as in seminoma

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5
Q

Diagnosis of testicular cancer

A

Clinical examination of testes

Imaging
- USS
- MRI

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6
Q

Microlithiasis

A

Calcium clusters in testes

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7
Q

Tumour markers for testicular cancer

A

AFP
- Non-seminoma

Beta-hCG
- 40-60% for NSGCT

1 or 2 markers elevated in NSGCT

30% of seminomas have elevated marker

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8
Q

Pre-operative for testicular cancer

A

Sperm banking
- Especially if family hasn’t been had

Serum tumour markers

Testicular prosthesis counselling

Contralateral testis biopsy

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9
Q

Radical orchiectomy
- Description
- Approach

A

Removal of testes

Approach
- Inguinal
- Incision just above inguinal ligament

Spermatic cord located and testes taken out via inguinal region

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10
Q

Post-op evaluation of testicular cancer

A

Histology of tumour

Staging
- CT (Chest, abdo, pelvis)

Tumour markers

Risk stratification
- Low risk= no vascular invasion
- High risk= vascular invasion

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11
Q

Treatment for NSGCT
- Low risk
- High risk

A

Low risk
- Surveillance
- Adjuvant chemo
- Nerve sparing RPLND (retroperitoneal lymph node dissection)

High risk
- Ochidectomy, chemo

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12
Q

Treatment for seminoma

A

Orchidectomy

Early stage
- Adjuvant irradiation
- Surveillance

Later stage
- Adjuvant chemo

Cure rate= >99%

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13
Q

Bladder cancer
- Incidence and sex

A

Incidence= 1:5000
- Trend has been increasing
- Third prevalent type of cancer

Sex= M>F 4:1

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14
Q

Bladder cancer
- Presentation

A

Microscopic Haematuria
- Primary symptom
- Painless

Dysuria, urinary frequency/ urgency

Recurrent UTis

Urinary retention

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15
Q

Bladder cancer
- Risk factors

A

Smoking

Genetic susceptibility
- NAT2

Amine exposure (rubber)

Iatrogenic: radiotherapy, cyclophosphamide, pioglitazone

Renal TCC

Chronic cystitis

Schistosomiasis

M>F

Older age

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16
Q

Grades of bladder cancer

A

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+

17
Q

Renal tumours
- Types

A

Renal Cell Carcinoma
- Most common

Transitional cell carcinoma
- 90% of lower UTI tumours but only 10% of renal tumours

18
Q

Renal cell cancer
- Risk factors

A

Smoking

obesity

HTN

Dialysis

Genetic
- Hereditary papillary RCC

19
Q

Renal Cell Carcinoma pathology

A

Adenocarcinoma

Subtypes
- Clear cell (glycogen)= most common
- Papillary
- Chromophobe
- Collecting duct (least common)

20
Q

Renal cancer mortality

A

5 year survival = 54%

21
Q

Renal cancer presentation

A

Most cases are incidental findings

Traid
- Haematuria
- Loin pain
- Loin mass

Systemic symptoms
- Anorexia, malaises, weight loss

Hypertension

metastasis: bone pain, haemoptysis, pathological fractures

22
Q

Paraneoplastic renal cancer presentation

A

Polycythaemia
- EPO

Hypercalcaemia
- PTHrP

Hypertension
- Renin

Cushing’s
- ACTH

Amyloidosis

23
Q

Renal cancer imaging

A

CT is gold standard
- Before and fater contrast

USS
- Sensitive but user-dependent

MRI for contrast allergy/ pregnancy

24
Q

Treatment of renal cancer

A

Localised
- Partial nephrectomy= laparoscopic/ robotic
- Cryo-ablation/ RFA (radiofrequency ablation)

Invasive/ large tumour
- Radical nephrectomy= laparoscopic

25
Q

Renal cancer tumour markers

A

CK7+
- More positive in chromophobe

CD15+
- More positive in oncoytoma

EpCAM+
- More positive in chromophobe

26
Q

Bladder cancer pathology

A

Most common
- Transitional cell carcinoma/ Urothelial

Squamous cell carcinoma
- Associated with schistosomiasis

Adenocarcinoma

27
Q

Bladder Cancer stages
- Ta/ Tis
- T1
- T2
- T3
- T4

A

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

28
Q

Bladder cancer
- Investigations

A

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

29
Q

Bladder cancer treatment
- Local
- high grade
- Invasive

A

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

30
Q

N staging for bladder cancer
- N1, 2, 3

A

N1
- Single LN metastasis in true pelvis

N2
- Muliple LN mets in true pelvis

N3
- Mets in Common iliac lymph node

31
Q

Cannonball metastases in the lungs is associated with which cancer?

A

Renal cell carcinoma

32
Q

Schistosomiasis is associated with developing what malignancy?

A

Squamous cell carcinoma of the bladder

33
Q

Indications for urgent cancer referral for haematuria

A

> 45 + unexplained visible haematuria without UTI or persistent UTI after treatment

> 60 with unexplained non-visible haematuria AND
- dysuria or
- Raised WCC

304: Urology + Breast (9 decks)

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