Urology: Urinary Tract Neoplasms Flashcards
what is the triad found in advanced renal disease?
- loin pain
- flank mass
- haematuria
fluid investigations for neoplasms
- urinalysis (haematuria)
- CBC (anaemia, polycythaemia)
- creatinine
- LFTs
- calcium (high)
radiological investigations in neoplasms
- IVP
- ultrasound
- CT scan
- CXR
- bone scan
- angiography/cavogram
- renal biopsy (rare)
how can RCC spread?
- local infiltration
- lymphatic: local and distant nodes
- blood: lung, bone, liver
- venous: renal vein, IVC, atrium
what are the stages of RCC?
- Stage 1: confined to the kidney
- Stage 2: local invasion of capsule only
- Stage 3: local nodes or renal vein involvement
- Stage 4: distant metastasis
features of paraneroplastic syndromes
- hypercalcaemia
- polycythaemia
- hypertension
treatment of localised RCC
- radical nephrectomy in localised disease
- partial lobectomy for solitary lung metastasis
treatment of metastatic disease
- tyrosine kinase inhibitors
- radiotherapy
- immunotherapy
- hormonal therapy
histological types of testicular cancer
- non-seminomatous (embryonal cell carcinoma, teratoma, choriocarcinoma, yolk sac)
- seminoma
- secondary tumours
risk factors for testicular cancer
- undescended testicle
clinical presentation of testicular cancers
- painless mass in the testicle
- weight loss
- back pain
differential diagnosis to testicular cancer
- hydrocoele
- hernia
- epididymal cyst
- torsion
- epididymitis
tumour markers in testicular cancers
- beta HCG
- alpha-fetoprotein
why are tumour markers important?
- if elevated after cancer surgery, it indicates metastasis
- monitors the response to treatment and sensitive for indicating disease relapse
radiological investigations of testicular cancer
- US testes
- metastatic work up: CT chest, abdomen, pelvis
treatment for testicular cancer
- radical inguinal orchidectomy
- radiotherapy (seminomas are radiosensitive)
- chemotherapy (cisplastin-based)
staging of testicular cancer
Stage 1: limited to the testicle
Stage 2: enlarged lymph nodes below the diaphragm
Stage 3: enlarged lymph nodes above the diaphragm or extranodal metastatic deposits
what type of cancer is a penile cancer?
squamous cell carcinoma
where can penile cancer spread to?
inguinal and pelvic lymph nodes and then to other organs
risk factors for penile cancer
- not being circumcised
- Balanitis Xerotica Obliterans
- genital warts
staging of penile cancer
Stage 1: confined to glans or prepuce
Stage 2: invasion into shaft of penis/no lymph nodes
Stage 3: inguinal lymph node spread
Stage 4: distant metastasis
clinical presentation of penile cancer
- patchy erythema, ulceration, warty growth, extensive destruction of the penile tissue
- itch or burning in a non-retractile foreskin
- painless
diagnosis and staging of penile cancer
- biopsy of the lesion
- CT abdomen and pelvis
treament of penile cancer
- wide local excision
- circumcision, glansectomy, partial penectomy
- total penectomy and perineal urethrostomy
- inguinal lymphadenectomy, radiotherapy and chemotherapy
what type of cancer is a bladder cancer?
transitional cell carcinoma (mainly)
risk factors for squamous cell bladder carcinoma
- schistosomiasis
- stones
- chronic irritation
risk factors for adenocarcinoma of the bladder
- urachal remnant
- vault of bladder
causes of bladder cancer
- smoking
- occupational chemical exposure
- analgesic abuse
- cyclophosphamide
- chronic bladder infection/irritation
signs and symptoms of bladder cancer
- painless haematuria
- irritative voiding symptoms (frequency, urgency, dysuria)
- recurrent UTIs
- signs of metastatic disease (perineal/loin/bone pain, anorexia, weight loss)
how can you diagnose a bladder cancer?
- cystoscopy
- urinalysis and urine culture
- urine cytology
- ultrasound, IVP, CT scan
- CBC, creatinine, LFTs
staging of transitional cell cancer
T1: confined to lamina propria
T2: invading muscle
T3: invading deep muscle
T4: involvement of adjacent structures
treatment for superficial TCC
- surgical (diathermy, TURBT)
- intravesical therapy (chemotherapy or immunotherapy)
- rarely cystectomy/radiotherapy
- metastatic disease: systemic chemotherapy
treatment for invasive TCC
- TURBT plus radiotherapy/cystectomy
follow up for TCC
- regular check cystoscopies
- ultrasound/ICP
- upper tract TCC in 5%
- palliative care
what happens in a cystectomy?
removal of the bladder, possibly the urethra also
- you have to rebuild a bladder usuing an ileal conduit (uretero-sigmoidoscopy), bladder reservoir with continent stoma, bladder reservoir onto urethra
