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Surgery II > Urology: Genitrourinary Tumours > Flashcards

Urology: Genitrourinary Tumours Flashcards

1
Q

types of malignant renal tumours

A
  • clear cell carcinoma
  • papillary renal carcinoma
  • chromophobe renal carcinoma
  • collecting duct carcinoma
  • renal cell carcinoma unclassified
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2
Q

types of benign renal tumours

A
  • oncocytoma
  • papillary adenoma
  • metanephric adenoma
  • angiomyolipomas
  • multilocular cyst
  • congenital mesoblastic nephroma
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3
Q

characteristics of multilocular cyst

A
  • unilateral
  • cluster of cysts
  • normal kidney surrounds these cysts
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4
Q

characteristics of congenital mesoblastic nephroma

A
  • presents in early infancy

- associated with polyhydramnios

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5
Q

characteristics of angiomyolipomas

A
  • present with catastrophic bleeding
  • diagnosed from US or CT
  • management: conservative unless v v torrential bleeding, this indicates a prophylactic nephrectomy/partial nephrectomy
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6
Q

characteristics of Wilms tumour

A
  • solid malignant tumour of embryonal renal tissue
  • nephroblastoma
  • 2 forms: hereditary or non-hereditary
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7
Q

syndromes associated with Wilms tumours

A
  • Wilms Aniridia Genitourinary abnormalities and retardation
  • Denys-Drash Syndrome (nephropathy and pseudohermaphroditism)
  • Beckwith-Wiedemann Syndrome - visceromegaly, omphalocoele, hemihypertrophy, microcephaly and mental retardation
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8
Q

how is Wilms tumour diagnosed?

A
  • abdominal pain
  • haematuria
  • physical exam: non tender mass
  • mainly asymptomatic
  • present in a toddler/young child
  • may present with hypertension
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9
Q

Stages of Wilms tumour

A 
Stage 1: limited to kidney
Stage 2: extends beyond kidney into vessels or if local spillage occurs or if biopsy is performed
Stage 3: residual tumour after resection
Stage 4: metastasis
Stage 5: bilateral Wilms
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10
Q

treatment of Wilms tumour

A
  • chemotherapy

- radiotherapy

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11
Q

aetiology of RCC

A
  • von Hippel Lindau disease
  • acquired renal cystic disease
  • smoking and obesity
  • family history
  • hypertension
  • tuberose sclerosis
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12
Q

what is von Hippel Lindau disease

A
  • autosomal dominant
  • increased risk of developing RCC
  • associated with: retinal and cerebellar haemangioblastma, phaeochromocytoma, renal, pancreatic and epidermal cysts, bilateral disease
  • treatment by partial/radical nephrectomy/transplantation
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13
Q

triad of tuberose sclerosis

A
  • epilepsy
  • mental retardation
  • adenoma sebaceum
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14
Q

what is tuberose sclerosis?

A
  • sometimes autosomal dominant
  • may be bilateral or unilateral, single or multiple
  • CNS has hamartoma usually on the cortex
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15
Q

triad of RCC

A
  • flank pain
  • mass
  • haematuria
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16
Q

clinical presentation of RCC

A
  • classic triad symptoms
  • weight loss, anaemia, ESR, neuropathy
  • left varicocoele but also right side
  • paraneoplastic syndrome
17
Q

investigation of RCC

A
  • blood:

- radiology: ultrasound, pre- and post-contrast CT, PET scans

18
Q

Staging of RCC

A

T1: <7cm; limited to kidney
T2: >7cm; limited to kidney
T3: into major veins; adrenal or perinephric invasion
T4: invades beyond gerota fascia

19
Q

management of RCC

A
  • radical nephrectomy
  • nephron-sparing surgery
  • embolisation to treat the haematuria
  • open partial or laparascopic using RF energy
  • excision of mets
  • newer TKI or high dose interleukin 2 treatment
  • palliative radiotherapy
20
Q

what does the prognosis of RCC depend on?

A
  • stage of the tumour
  • capsular penetration into Gerota’s fascia
  • IVC involvement does not make the prognosis worse
21
Q

what is everolimus?

A
  • mTor inhibitor
  • serine/threonine protein kinase
  • regulates:
    • cell growth
    • cell proliferation
    • cell motility
    • cell survival
    • protein synthesis
    • transcription
22
Q

what is subitinib?

A

tyrosine kinase inhibitor

23
Q

why is smoking a risk factor for bladder cancer?

A

carcinogens in tobacco become concentrated in the urine and eventually damage the bladder lining

24
Q

treatment of superficial bladder cancer

A
  • transurethral resection

- adjuvant therapy (doxorubicin, mitomycin C, BCG)

25
Q

treatment of invasive bladder cancer

A
  • radical cystectomy with pelvic lymphadenopathy

- if you want to spare the bladder, radiotherapy

26
Q

diagnosis of bladder cancer

A
  • haematuria
  • IVU
  • urinary cytology
  • CT/MRI
  • cystoscopy
27
Q

TN staging of penile cancers

A

T1: subepithelial connective tissue
T2: corpus cavernosum or spongiosum
T3: urethra or prostate
T4: adjacent structures

N1: one superficial inguinal
N2: multiple or bilateral superficial inguinal
N3: deep inguinal or pelvic

28
Q

surgical management of penile cancer

A
  • biopsy
  • superficial lesion: 5FU cream
  • deeper lesion: excision
  • radiotherapy may be used but this causes long term damage to the penis
  • partial glans amputation and resurfacing of the corpora cavernosa
  • block dissection os inguinal lymph nodes, if needed
29
Q

history of testicular cancer

A
  • painful lump on the testes
  • history of undescended testes
  • prenatal exposure to diethylstilboestrol
  • radiation exposure
30
Q

examination of testicular cancer

A
  • feel lump and compare to the other side
  • look for surgical scars
  • consistency of lump
  • associated redness of scrotum or LUTS
  • any abdominal swelling
31
Q

bloods investigation of testicular cancer

A
  • CBC
  • renal function
  • tumour markers
32
Q

radiological investigation of testicular cancer

A
  • US testes (inflammation and microcalcification)

- CT scan (mets and lymph node masses)

33
Q

staging of testicular cancer

A

T1: testis and epididymis, no vascular/lymphatic invasion
T2: testis and epididymis with vascular/lymphatic invasion or tunica vaginalis
T3: spermatic cord
T4: scrotum

34
Q

treatment of testicular cancer

A
  • orchidectomy (groin incision)
  • semen analysis before surgery
  • cord clamp
  • contralateral biopsy particularly in atrophic testis
  • chemotherapy
  • surveillance with CT and tumour markers

Surgery II (19 decks)

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