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Surgery II > Urology: Urinary Tract Neoplasms > Flashcards

Urology: Urinary Tract Neoplasms Flashcards

1
Q

what is the triad found in advanced renal disease?

A
  • loin pain
  • flank mass
  • haematuria
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2
Q

fluid investigations for neoplasms

A
  • urinalysis (haematuria)
  • CBC (anaemia, polycythaemia)
  • creatinine
  • LFTs
  • calcium (high)
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3
Q

radiological investigations in neoplasms

A
  • IVP
  • ultrasound
  • CT scan
  • CXR
  • bone scan
  • angiography/cavogram
  • renal biopsy (rare)
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4
Q

how can RCC spread?

A
  • local infiltration
  • lymphatic: local and distant nodes
  • blood: lung, bone, liver
  • venous: renal vein, IVC, atrium
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5
Q

what are the stages of RCC?

A
  • 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
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6
Q

features of paraneroplastic syndromes

A
  • hypercalcaemia
  • polycythaemia
  • hypertension
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7
Q

treatment of localised RCC

A
  • radical nephrectomy in localised disease

- partial lobectomy for solitary lung metastasis

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8
Q

treatment of metastatic disease

A
  • tyrosine kinase inhibitors
  • radiotherapy
  • immunotherapy
  • hormonal therapy
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9
Q

histological types of testicular cancer

A
  • non-seminomatous (embryonal cell carcinoma, teratoma, choriocarcinoma, yolk sac)
  • seminoma
  • secondary tumours
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10
Q

risk factors for testicular cancer

A
  • undescended testicle
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11
Q

clinical presentation of testicular cancers

A
  • painless mass in the testicle
  • weight loss
  • back pain
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12
Q

differential diagnosis to testicular cancer

A
  • hydrocoele
  • hernia
  • epididymal cyst
  • torsion
  • epididymitis
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13
Q

tumour markers in testicular cancers

A
  • beta HCG

- alpha-fetoprotein

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14
Q

why are tumour markers important?

A
  • if elevated after cancer surgery, it indicates metastasis

- monitors the response to treatment and sensitive for indicating disease relapse

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15
Q

radiological investigations of testicular cancer

A
  • US testes

- metastatic work up: CT chest, abdomen, pelvis

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16
Q

treatment for testicular cancer

A
  • radical inguinal orchidectomy
  • radiotherapy (seminomas are radiosensitive)
  • chemotherapy (cisplastin-based)
17
Q

staging of testicular cancer

A

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

18
Q

what type of cancer is a penile cancer?

A

squamous cell carcinoma

19
Q

where can penile cancer spread to?

A

inguinal and pelvic lymph nodes and then to other organs

20
Q

risk factors for penile cancer

A
  • not being circumcised
  • Balanitis Xerotica Obliterans
  • genital warts
21
Q

staging of penile cancer

A

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

22
Q

clinical presentation of penile cancer

A
  • patchy erythema, ulceration, warty growth, extensive destruction of the penile tissue
  • itch or burning in a non-retractile foreskin
  • painless
23
Q

diagnosis and staging of penile cancer

A
  • biopsy of the lesion

- CT abdomen and pelvis

24
Q

treament of penile cancer

A
  • wide local excision
  • circumcision, glansectomy, partial penectomy
  • total penectomy and perineal urethrostomy
  • inguinal lymphadenectomy, radiotherapy and chemotherapy
25
Q

what type of cancer is a bladder cancer?

A

transitional cell carcinoma (mainly)

26
Q

risk factors for squamous cell bladder carcinoma

A
  • schistosomiasis
  • stones
  • chronic irritation
27
Q

risk factors for adenocarcinoma of the bladder

A
  • urachal remnant

- vault of bladder

28
Q

causes of bladder cancer

A
  • smoking
  • occupational chemical exposure
  • analgesic abuse
  • cyclophosphamide
  • chronic bladder infection/irritation
29
Q

signs and symptoms of bladder cancer

A
  • painless haematuria
  • irritative voiding symptoms (frequency, urgency, dysuria)
  • recurrent UTIs
  • signs of metastatic disease (perineal/loin/bone pain, anorexia, weight loss)
30
Q

how can you diagnose a bladder cancer?

A
  • cystoscopy
  • urinalysis and urine culture
  • urine cytology
  • ultrasound, IVP, CT scan
  • CBC, creatinine, LFTs
31
Q

staging of transitional cell cancer

A

T1: confined to lamina propria
T2: invading muscle
T3: invading deep muscle
T4: involvement of adjacent structures

32
Q

treatment for superficial TCC

A
  • surgical (diathermy, TURBT)
  • intravesical therapy (chemotherapy or immunotherapy)
  • rarely cystectomy/radiotherapy
  • metastatic disease: systemic chemotherapy
33
Q

treatment for invasive TCC

A
  • TURBT plus radiotherapy/cystectomy
34
Q

follow up for TCC

A
  • regular check cystoscopies
  • ultrasound/ICP
  • upper tract TCC in 5%
  • palliative care
35
Q

what happens in a cystectomy?

A

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

Surgery II (19 decks)

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