Urology Path (1/2 GU) Flashcards
Breakdown % of bladder and ureteric tumours
84%: TCC
10%: Squamous ca
5%: Adenocarcinoma
1%: Misc
What type of epithelium lines the bladder and ureter?
Transition cell epithelium
What infection is associated with Squamous ca?
Schistosomiasis
How invasive is TCC of bladder/ureter?
- Often the first tumour is not invasive
- But it often recurs
- When the tumour recurs it is more invasive
RF for Bladder/Ureter tumours?
Smoking
Aniline dye exposure (Rubber industry)
Hydrocarbon exposure
Males
Presentation of Bladder/Ureteric tumours
- Lower urinary tract sx (LUTs)
- Haematuria (may be micro)
- Palpable mass (Rare)
Investigations Bladder/Ureteric tumours
Cystoscopy + Biopsy/ Transurethral resection
CT
IVUrogram
MRI
Dx this:
Red lesions see on cystoscopy
Transitional cell Carcinoma in sitiu
Dx this:
Polypoid lesions on cystoscopy
Superficial TCC
Dx this:
Pale , flat, ulcerated and necrotising lesion on cystoscopy
Invasive Transitional cell carcinoma
What embryonic abnormality is bladder adenocarcinoma associated with?
Urachus
Stump that should’ve formed the median umbilical ligament
Where are bladder adenocarcinomas located?
Dome of bladder
Histology of bladder adenocarcinoma
Papillary and Glandular tumours
Staging of bladder/ureteric tumours
pTa: non-invasive
pT1: Submucosal invasion
pT2: Muscularis propria invasion
pT3: Invasion beyond Muscularis propria
pT4: Spread to adjacent organs
Management of Bladder cancer
- Surgery
- TURBT (tumour resection) in low risk
- Cystectomy + ileal conduit (Stoma) if T2+ - Oncology
- BCG
- +/-Chemoradio
Complication of bladder carcinoma in sitiu
Often TCC present also
Rx bladder ca in sitiu
BCG
+ Surgery if TCC also present
Complications of ureteric TCC
Often bilateral/multifocal
Often occur alongside TCC bladder
What are the 4 malignant tumours of the penis?
Squamous cell ca
Malignant melanoma (rare)
Spindle cell ca
Adenosquamous ca
RF for penile cancers
4
Poor hygiene
Uncircumcised
HPV
Smoking
Pre-neoplastic penile conditions
3
Bowenoid papulosis
Erythroplasia de Queyrat
Bowens disease
Cause of Bowenoid Papulosis
HPV
Presentation of Bowenoid Papulosis
Red/Brown spots on skin of genitals
Epi of Bowenoid Papulosis
Young sexually active males
Epi of Erythroplasia de Queyrat
Elderly males
What is Erythroplasia de Queyrat?
CIS of foreskin (Glans Penis)
What is Bowens disease?
Dysplasia of skin
Non-Neoplastic Testicular Diseases
3
Epididymo-orchitis
Torsion
Hydrocoele
Non-neoplastic testicular emergency
Torsion
Need intervention within 24hrs
Cause of Epididymo-orchitis
Infalmmation following UTI or STI
Pathogenesis of testicular torsion
Spermatic cord twists
Blood supply to the testes is cut off
Will result in infarction if no intervention
Epi of Testicular torsion
Young males
Presentation of testicular torsion
Intense pain
Pathogenesis of testicular hydrocoele
Accumulation of fluid in the scrotum
Epi of testicular hydrocoele
Older males
Newborns
Cause of Testicular Hydrocoele
Trauma or UTI
Treatment of testicular torsion
Surgery to untwist vessels and suture them in a way that it can recur
Epi testicular cancer
Young males
Types of testicular germ cell tumours
% breakdown
Seminoma 50%
Mixed germ cell 33%
Non-seminomatous GCT (Teratoma) 15%
Epi of testicular seminoma
40-50 y/o
Macroscopic features of testicular seminoma
Fleshy pale
Microscopic features of testicular seminoma
- Sheets of large cells
- Lymphoid stroma
- No spermatogenesis in the cells near the tumour
British Testicular pannel classification of Teratomas
Malignant Teratoma:
MTD: Differentiated
MTI: Intermediate:
MTU: Undifferentiated
MTT: Trophoblastic
Types of Teratomas
5
Malignant Teratoma
Embryonal ca
Yolk sac
Choriocarcinoma
Polyembryona
Microscopic features of Embryonal ca
2
Spindle
Glands
Microscopic features of Choriocarcinoma
3
Haemorrhagic
Giant cells
Cytotrophoblasts
Microscopic features of Yolk Sac Tumour
Central vessel
Double rim of epithelial cells
Schiller- du- val body
Worst prognostic feature to see in a teratoma?
Primitive neural tissue
Doesn’t respond to chemo
Presentation of tumour
Testicular mass
Painless
What blood test would indicate seminoma?
Elevated LDH (Lactate dehydrogenase)
What serum marked would you expect to find elevated in Teratomas?
Raised:
AFP (a-fetaprotein)
HCG (human chroionic gonadotropin)
Where to testicular tumers metastasise?
Lymph nodes
Lung
Brain
Rx testicular ca
Radical orchidectomy
+
Chemo if 2+ of these factors:
- Lymph invasion
- Vascular invasion
- Embryonal ca
- Not a Yolk sac tumour
5 year survival of seminoma
95%
5 year survival of teratoma
90%
Benign conditions of the prostate
2
BNH
Proststitis
Cause of BNH
Androgen:Oestrogen imbalance
Microscopic features of prostate
Proliferation of glands and stroma
Rx BNH
- Drugs:
- a-blockers: Doxazosin/ Tamsulosin
- 5-a reductase inhibitors: Finasteride/ Dutasteride - Trans urethral resection of the prostate
- Look for ca
Most common tumour in males
Prostate
Prostate met sites
Bones
What types of prostate ca are there?
Acinar - 90%
Ductal 5%
Signs of Prostate ca
Outflow obstruction
Haematuria
Enlarged prostate on PR exam
Elevated PSA
Ix prostate ca
PSA
PR
Trans Rectal Ultrasound Biopsy (TRUS)
MRI/CT Pelvis
Bone scan
Rx Prostate ca
- Radiotherapy
- Hormonal therapy (if poorly differentiated or high Gleason Score)
- Radical Prostatectomy if PSA<15 and <65y/o
- Brachytherapy (radioisotope beads into prostate)
How are prostate tumours graded?
Gleason score
How does Gleason score work?
Grade two commonest parts of the biopsy from 1-5 each
Then add up the two scores
How are Prostate tumours graded
pt1 - biopsy or TURP
pT2- Confined to 2 lobes of the prostate
pT3 Spread into capsule/seminal vesicle
pT4- Spread to adjacent organs eg. Rectum, bladder
What 3 factors determine prostate ca prognosis?
Grade
Stage
PSA level
Length of male urethra
20cm
What are the 3 sections of the male urethra?
Prostatic urethra
Membranous urethra
Penile urethra
Length of female urethra
3-4cm
RF for cystitis
Female Pregnancy BNH Catheterisation DM Radiotherapy
Genetics associated with bladder cancer
Mutation in Tumour suppressor gene p16 on chr 9
What is hypospadias?
Urinary meatus opens on the ventral surface of the penis
What is epispadias?
Where the urinary meatus is on the dorsal surface of the penis
What HPV types are associated with penis cancer?
HPV 16 and 18
What is cryptorchidism?
Undescended testes
What congenital syndrome is cryptorchidism linked to?
Prader Willi
Which side is most commonly affected by cryptorchidism?
Right side
But can be bilateral
Complications of cryptorchidism
Infertility
Cancer (decreased risk if problem sorted before puberty)
What lab finding is found in 10% of seminomas?
B-hCG
How/ where does seminomatous tumours spread?
Lymphatic spread
Iliac and para-aortic nodes
Which testicular tumours are hormonally active?
Stromal/sex cord tumours
Leydig tumours
Which part of the prostate is commonly affected in BNH?
Central
Signs of Prostate ca
Haematuria
Outflow problems
Bone pain
