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1B Urology and Renal Medicine > Urology cancers > Flashcards

Urology cancers Flashcards

1
Q

what is the type of majority of kidney cancer?

A

renal cell carcinoma (adenocarcinoma)

then transitional cell carcinoa

then sarcoma

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2
Q

what are the risk factor for kidney cancer?

A
  • Smoking
  • Renal failure
  • Dialysis
  • Obesity
  • Hypertension
  • Genetic predisposition- Von Hippel Lindau syndrome (50% individuals will develop RCC)
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3
Q

what are the clinical features of kidney cancer?

A
  • Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
  • Additional Features of RCC include
    • Loin pain
    • Palpable mass
    • Metastatic disease symptoms –bone pain, haemoptysis
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4
Q

what are the investigations for painless visible haematuria?

A
  • Flexible cystoscopy
  • CT urogram
  • Renal function
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5
Q

what are the investigations for persistent non-visible haematuria

A
  • Flexible cystoscopy
  • US Kidneys (KUB)
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6
Q

what are the investigations for suspected kidney cancer?

A

CT renal triple phase

staging CT chest

bone scan if symptomatic

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7
Q

what is the TNM staging of renal cell carcinoma?

A
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8
Q

what is the grading of RCC?

A
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9
Q

what is the management of kidney cancer?

A
  • Patient specific ( depends on the ASA status, comorbidities, classification of lesion)
  • Gold standard is excision either via:
    • Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)
    • Radical Nephrectomy
  • In patients with small tumours unfit for surgery- cryosurgery
  • Metastatic disease
    • Receptor tyrosine kinase inhibitors
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10
Q

what is the epidemiology of bladder cancer?

A

11th most common in UK

incidence and mortality declining

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11
Q

what are the types of bladder cancer?

A
  • >90% of bladder cancer is transitional cell carcinoma,
  • 1-7% squamous cell carcinoma (75% SCC where schistosomiasis is endemic),
  • Adenocarcinoma(2%)
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12
Q

what are the risk factors of bladder cancer?

A
  • Smoking
  • Occupational exposure (aromatic hydrocarbons)
  • Chromic inflammation of bladder (bladder stones, schistosomiasis, long term catheter)
  • Drugs (cyclophosphamide)
  • Radiotherapy
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13
Q

what are the clinical feature of bladder cancer?

A
  • Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
  • Additional Features of bladder cancer include
    • Suprapubic pain
    • Lower urinary tract symptoms
    • Metastatic disease symptoms –bone pain, lower limb swelling
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14
Q

what is the staging of bladder cancer?

A
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15
Q

what is the grading of bladder cancer?

A
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16
Q

what can be done to determine stage/grade of bladder cancer?

A

Cystoscopy and transurethral resection of bladder lesion:

  • A transurethral resection of bladder lesion uses heat to cut out all visible bladder tumour.
  • This provides histology and also can be curative.
  • However, if the tumour extends beyond muscle then the resection is incomplete due to the risk of perforating the bladder
17
Q

what is the management of non-muscle invasive bladder cancer?

A

if low grade and no CIS then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG

18
Q

what is the management for muscle-invasive bladder cancer?

A

cystectomy

radiotherapy

+/- chemotherapy

palliative treatment

19
Q

what is the epidemiology of prostate cancer?

A

most common cancer in men in UK

incidence risking but mortality rates declining

20
Q

what are the types of prostate cancer?

A

>95% adenocarcinoma

21
Q

what are the risk factors for prostate cancer?

A

increasing age

western nations (Scandinavian countries)

ethnicity (African american)

22
Q

what are the clinical features of prostate cancer?

A

usually asymptomatic unless metastatic

23
Q

what are the investigations of prostate cancer?

A

blood tests

MRI

transperineal prostate biopsy

24
Q

what are the blood tests for prostate cancer?

A
  • PSA is prostate-specific but not prostate-cancer specific
  • Can be elevated (UTI, prostatitis)
25
Q

when is MRI done in suspected prostate cancer?

A
  • imaging prior to biopsy testing.
  • Historically random biopsies of the prostate were associated with an under detection of high grade (clinically significant) prostate cancer and over detection of low grade(clinically insignificant) prostate cancer
  • use of risk assessment with multiparametric MRI before biopsy and MRI targeted biopsy is superior to the previous gold standard of transrectal ultrasonography-guided prostate biopsies
26
Q

what is transperineal prostate biopsy?

A

systematic template biopsies of the prostate

27
Q

why is transperineal prostate biopsy used over transrectal?

A

less risk infection and able to sample all areas of the prostate

28
Q

what is the staging of prostate cancer?

A
29
Q

what is the grading for prostate cancer?

A
30
Q

what is the management of prostate cancer?

A
  • Highly dependent on patient age/comorbidities and stage and grade of prostate cancer
  • If young and fit
      • High grade cancer -> Radical prostatectomy/Radiotherapy
    • +Low grade cancer Active surveillance ( Regular PSA, MRI and Bx)
  • Post prostatectomy – monitor PSA ( should be undetectable or <0.01ng/ml). If >0.2ng/ml then relapse
  • If old/unfit
      • high grade cancer/Metastatic disease à Hormone therapy
      • Low grade cancer Watchful waiting (regular PSA testing)
31
Q

what are the side effects of prostatectomy?

A
  • Prostatectomy removes the proximal urethral sphincter
    • risk of damage to the cavernous nerve to the prostate
    • (which provides neural innervation to the bladder and urethra) resulting in bladder function being affected
  • urethral length changes during the operation which can also affect continence.
32
Q

what is the treatment for incontinence post-prostatectomy?

A

The main treatment for this type of incontinence is building the pelvic floor muscles through exercises

should this fail there is an option for an artificial urinary sphincter device.

1B Urology and Renal Medicine (6 decks)

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