💧Urology💧- Urological Cancers Flashcards
What are the types of kidney cancer?
Adenocarcinoma (85%)
Transitional cell carcinoma (10%)
Other types (5%)
What are the risk factors for kidney cancer?
Smoking
Renal failure and subsequent dialysis
Obesity
Hypertension
Genetic predisposition with Von Hippel-Lindau syndrome (50% of individuals will develop RCC)
What is a red flag symptom for kidney cancer (and any urological cancer)?
Painless haematuria/persistent microscopic haematuria
What is RCC?
Renal cell carcinoma
Apart from haematuria, what are the other clinical features of RCC?
Loin pain
Palpable mass
Metastatic disease symptoms - bone pain, haemoptysis
What are the main types of RCC?
Clear cell - 75%
Papillary - 15%
Chromophobe - 5%
What are the general symptoms of renal cancer?
Haematuria
Back pain that doesn’t go away
Unexplained weight loss/loss of appetite
Fatigue
Intermittent fever
Lump on side, belly or lower back
Anaemic
Hyperkalaemia
Hypertension
What are the investigations with painless visible haematuria?
Flexible cystoscopy
CT urogram
Renal function
What are the investigations with persistent non-visible haematuria?
Flexible cystoscopy
US KUB (kidney, ureter and bladder ultrasound)
What are the kidney cancer investigations in a patient with strongly suspected kidney cancer?
CT renal triple phase
Staging CT chest
Bone scan if symptomatic
What are the stages of kidney cancer?
What is the ideal management option for kidney cancer?
Excision via:
Partial nephrectomy (T1 tumours)
Radical nephrectomy
What are the types of bladder cancer?
Transitional cell carcinoma (>90%)
Squamous cell carcinoma (1-7%)
Adenocarcinoma (2%)
What are the risk factors for bladder cancer?
Smoking
Occupational exposure (aromatic hydrocarbons)
Chronic inflammation of bladder (bladder stones, schistosomiasis, long term catheter)
Drugs (cyclophosphamide)
Radiotherapy
What is the management for kidney cancer which has progressed to metastatic disease?
Receptor tyrosine kinase inhibitors
Immunotherapy
What is the management for patients with small kidney tumours who are unfit for surgery?
Cryosurgery
What are the clinical features of bladder cancer?
Painless haematuria/persistent microscopic haematuria is a red flag
Suprapubic pain
Lower urinary tract symptoms (flow of urine, frequency etc…) and UTIs
Metastatic disease symptoms –bone pain, lower limb swelling
What is the staging for bladder cancer?
Give the surgical option for removal of a bladder tumour/lesion
What does the management protocol for bladder cancer tell us should be done with a non muscle invasive tumour?
If low grade and no CIS then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG
What does the management protocol for bladder cancer tell us should be done with a muscle invasive tumour?
Cystectomy
Radiotherapy
+/- chemotherapy
Palliative treatment
What are the types of prostate cancer?
> 95% of prostate cancer is adenocarcinoma
What are the risk factors for prostate cancer?
Increasing age
Western nations (particularly Scandinavia)
Ethnicity (African-English, African-American)
What are the presenting features of prostate cancer?
Usually asymptomatic unless metastatic
What is PSA?
PSAis anenzyme(serine protease) normally produced by the glandular tissue of the prostate. It is produced at detectable levels only byprostate tissue
PSA may be increased by trauma to the prostate (such as occurs after biopsy or cystoscopy), infection, benign enlargement, orprostate cancer
What does an elevated PSA mean?
Prostatic enlargement or increased activity
NOT NECESSARILY prostate cancer
How can PSA be used diagnostically?
PSA is prostate-specific but not prostate-cancer specific (Can be elevated in: UTI, prostatitis, Benign prostatic hyperplasia)
What investigation should be done to confirm the presence of prostate cancer?
Transperineal prostate biopsy
Describe the staging of prostate cancer
Describe the Gleason grading scale
What is the management for high grade prostate cancer if young and fit?
Radical prostactectomy
/radiotherapy
/Focal
What is the management for low grade prostate cancer if young and fit?
Active surveillance
Regular PSA, MRI and Bx
How is prostate cancer monitored post prostatectomy?
Monitor PSA ( should be undetectable or <0.01ng/ml)
If >0.2ng/ml then relapse
What is the management for high grade prostate cancer if old/unfit?
Hormone therapy
What is the management for low grade prostate cancer if old/unfit?
Watchful waiting (regular PSA testing)
What are the treatment side effects for prostate cancer?
The prostate contains the proximal sphincter
Prostatectomy removes the proximal urethral sphincter and changes urethral length
Risk of damage to cavernous nerves ( innervation to bladder and urethra)
Damage to cavernous nerves causes ED
What should be considered a red flag symptom for all urological cancers?
Painless visible haematuria
What should happen to patients with suspected prostate cancer?
MRI imaging
What investigation should be done to confirm the presence of prostate cancer after positive imaging results?
Transperineal prostate biopsy
What is the Gleason score?
A grading system used to assess the aggressiveness of prostate cancer based on how abnormal the cancer cells look under a microscope
How does the Gleason score work?
Prostate cancer cells are graded on a scale from 1 to 5, with:
Grade 1 = Cells look almost normal (least aggressive)
Grade 5 = Cells look very abnormal (most aggressive)
What is Gleason score 3+4 vs 4+3?
The first number represents the most common pattern of cancer cells in the sample
The second number represents the second most common pattern
These two are added together to give the final Gleason Score
First score, majority of cells are Grade 3
Second score, majority of cells are Grade 4
Same Gleason score, but 2nd score is more aggressive
