Urology: Genitrourinary Tumours Flashcards
types of malignant renal tumours
- clear cell carcinoma
- papillary renal carcinoma
- chromophobe renal carcinoma
- collecting duct carcinoma
- renal cell carcinoma unclassified
types of benign renal tumours
- oncocytoma
- papillary adenoma
- metanephric adenoma
- angiomyolipomas
- multilocular cyst
- congenital mesoblastic nephroma
characteristics of multilocular cyst
- unilateral
- cluster of cysts
- normal kidney surrounds these cysts
characteristics of congenital mesoblastic nephroma
- presents in early infancy
- associated with polyhydramnios
characteristics of angiomyolipomas
- present with catastrophic bleeding
- diagnosed from US or CT
- management: conservative unless v v torrential bleeding, this indicates a prophylactic nephrectomy/partial nephrectomy
characteristics of Wilms tumour
- solid malignant tumour of embryonal renal tissue
- nephroblastoma
- 2 forms: hereditary or non-hereditary
syndromes associated with Wilms tumours
- Wilms Aniridia Genitourinary abnormalities and retardation
- Denys-Drash Syndrome (nephropathy and pseudohermaphroditism)
- Beckwith-Wiedemann Syndrome - visceromegaly, omphalocoele, hemihypertrophy, microcephaly and mental retardation
how is Wilms tumour diagnosed?
- abdominal pain
- haematuria
- physical exam: non tender mass
- mainly asymptomatic
- present in a toddler/young child
- may present with hypertension
Stages of Wilms tumour
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
treatment of Wilms tumour
- chemotherapy
- radiotherapy
aetiology of RCC
- von Hippel Lindau disease
- acquired renal cystic disease
- smoking and obesity
- family history
- hypertension
- tuberose sclerosis
what is von Hippel Lindau disease
- 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
triad of tuberose sclerosis
- epilepsy
- mental retardation
- adenoma sebaceum
what is tuberose sclerosis?
- sometimes autosomal dominant
- may be bilateral or unilateral, single or multiple
- CNS has hamartoma usually on the cortex
triad of RCC
- flank pain
- mass
- haematuria
clinical presentation of RCC
- classic triad symptoms
- weight loss, anaemia, ESR, neuropathy
- left varicocoele but also right side
- paraneoplastic syndrome
investigation of RCC
- blood:
- radiology: ultrasound, pre- and post-contrast CT, PET scans
Staging of RCC
T1: <7cm; limited to kidney
T2: >7cm; limited to kidney
T3: into major veins; adrenal or perinephric invasion
T4: invades beyond gerota fascia
management of RCC
- 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
what does the prognosis of RCC depend on?
- stage of the tumour
- capsular penetration into Gerota’s fascia
- IVC involvement does not make the prognosis worse
what is everolimus?
- mTor inhibitor
- serine/threonine protein kinase
- regulates:
- cell growth
- cell proliferation
- cell motility
- cell survival
- protein synthesis
- transcription
what is subitinib?
tyrosine kinase inhibitor
why is smoking a risk factor for bladder cancer?
carcinogens in tobacco become concentrated in the urine and eventually damage the bladder lining
treatment of superficial bladder cancer
- transurethral resection
- adjuvant therapy (doxorubicin, mitomycin C, BCG)
treatment of invasive bladder cancer
- radical cystectomy with pelvic lymphadenopathy
- if you want to spare the bladder, radiotherapy
diagnosis of bladder cancer
- haematuria
- IVU
- urinary cytology
- CT/MRI
- cystoscopy
TN staging of penile cancers
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
surgical management of penile cancer
- 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
history of testicular cancer
- painful lump on the testes
- history of undescended testes
- prenatal exposure to diethylstilboestrol
- radiation exposure
examination of testicular cancer
- feel lump and compare to the other side
- look for surgical scars
- consistency of lump
- associated redness of scrotum or LUTS
- any abdominal swelling
bloods investigation of testicular cancer
- CBC
- renal function
- tumour markers
radiological investigation of testicular cancer
- US testes (inflammation and microcalcification)
- CT scan (mets and lymph node masses)
staging of testicular cancer
T1: testis and epididymis, no vascular/lymphatic invasion
T2: testis and epididymis with vascular/lymphatic invasion or tunica vaginalis
T3: spermatic cord
T4: scrotum
treatment of testicular cancer
- orchidectomy (groin incision)
- semen analysis before surgery
- cord clamp
- contralateral biopsy particularly in atrophic testis
- chemotherapy
- surveillance with CT and tumour markers
