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MBChB3 > Urooncology > Flashcards

Urooncology Flashcards

1
Q

What are the risk factors of prostate cancer?

A
  • age (>65)
  • familial and genetic factors (BRCA2, PTEN and TP53)
  • hormones
  • race (Afro-Carribean)
  • geography (western)
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2
Q

What is the clinical presentation of prostate cancer?

A

Local:
- often asymptomatic (or raised PSA in screening)
- painful or slow micturition
- UTI
- haematuria
- urinary retention (anuria, uraemia)
- lymphoedema

Metastatic:
- bone pain
- renal failure

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3
Q

Describe the pathology of prostate carcinoma

A
  • majority is primary adenocarcinoma in peripheral zone of prostate
  • Gleason grading system used
  • 6: well differentiated (25% 10y progression)
  • 7: moderately differentiated (50% 10y progression)
  • > 7: poorly differentiation (75% 10y progression)
  • TNM staging classification
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4
Q

Describe the TNM staging of prostate cancer

A
  • T1: no abnormality felt in prostate but tumour present within walls
  • T2: abnormality felt on examination, raised PSA, still within wall of gland
  • T3: tumour has burst through wall of gland
  • T4: burst through prostate wall and involvement of adjacent structures
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5
Q

What is PSA and what does it do?

A
  • serine protease secreted into seminal fluid
  • liquifies seminal coagulation to hydrolyse semenogelins allowing release of sperm
  • small amount released into circulation
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6
Q

What states will cause a rise in PSA?

A
  • age
  • size
  • cancer
  • inflammation, infection etc
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7
Q

What is the treatment of localised prostate cancer?

A
  • watch and wait
  • surveillance
  • radiotherapy (external beam, conformal, brachytherapy)
  • cryotherapy/HIFU
  • TURP if symptomatic (surgical resection)
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8
Q

Describe the metastatic complications of prostate cancer and the signs of it

A
  • spinal cord compression: urological emergency, severe pain, retention, constipation
  • ureteric obstruction: anorexia, weight loss, raised creatinine
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9
Q

What is the treatment for advanced prostate cancer?

A
  • androgen ablation therapy (medical castration - LHRH analogue) or surgical (orchidectomy)
  • chemotherapy
  • TURP for symptoms
  • radiotherapy
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10
Q

What are the risk factors for bladder cancer?

A
  • age (80+)
  • race (white)
  • environmental carcinogens
  • chronic inflammation (stones, infection, long-term catheters etc.)
  • drugs (eg. phenacetin, cyclophosphamide)
  • pelvic radiotherapy
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11
Q

Describe the presentation and investigation of bladder cancer

A
  • painless frank haematuria
  • some with microscopic haematuria
  • all require cystoscopy, renal US (kidney, urethra and bladder)
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12
Q

Describe the pathology of bladder cancer

A
  • majority = transitional cell cancer (superficial 75% and invasive 25%
  • squamous carcinoma
  • adenocarcinoma
  • secondary malignancies
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13
Q

Describe the treatment of bladder cancer

A
  • urgent TURBT (surgical resection of tumour)
  • CT intravenous urogram (look for upper tract involvement in renal pelvis)
  • bimanual exam
  • IV mitomycin to reduce recurrence
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14
Q

How are superficial bladder tumours treated to prevent recurrence?

A
  • low grade superficial = low chance of recurrence but 6 week mitomycin can be given
  • high grade superficiall = very high chance of recurrence, intravesical BCG immunotherapy
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15
Q

How is bladder cancer with muscle involvement treated?

A
  • radical cystectomy or radiotherapy
  • if widespread or multifocal radiotherapy not best choice
  • Neo-adjuvant chemo
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16
Q

What is involved in a radical cystectomy?

A
  • bladder and prostate/uterus removed
  • urine diverted into ideal conduit or orthotropic neobladder (rare)
17
Q

How is metastatic bladder cancer treated?

A
  • often pulmonary metastasis
  • MVAC chemo = methotrexate, vinblastine, doxorubicin, cisplatin (highly toxic)
  • gemicitobine/docetaxel
18
Q

What are the risk factors for renal cell carcinoma?

A
  • smoking
  • obesity
  • hypertension
  • acquired renal cystic disease
  • haemodialysis
  • genetics
19
Q

Describe the clinical presentation of renal cell carcinoma

A
  • 80% incidental
  • systemic symptoms (fever, night sweats, weight loss)
  • haemoptysis
  • mass, pain, haematuria
  • varicocele
  • lower limb oedema
  • paraneoplastic syndrome
20
Q

Describe the associations of paraneoplastic syndromes with renal cell carcinoma?

A
  • polycythaemia (increased EPO)
  • hypercalcaemia (PTH-like substance, osteolytic hypercalcaemia)
  • hypertension (renin)
  • deranged LFTs (Stauffer syndrome from hepatotoxic tumour products)
21
Q

Describe the histology of renal cell carcinoma

A
  • clear cell (80%) = vascular, granular and clear with lipids
  • papillary (10%) = solid and multifocal
  • chromophore (5%) = large, polygonal
  • collecting duct and medullary cell (rare)
22
Q

Describe the staging of renal cell carcinoma

A
  • T1a = <4cm
  • T1b = 4-7cm
  • T2 = >7cm
  • T3a = invasion into renal vein
  • T3b = IVC below diaphragm
  • T3c = IVC above diaphragm
  • T4 = beyond Gerota’s fascia and/or adrenal gland
23
Q

Describe the treatment of renal cell carcinoma

A
  • large renal mass: radical nephrectomy (removal of kidney and Gerota’s fascia but sparing adrenal gland)
  • small renal mass: biopsy, treatment with nephron sparing surgery (partial nephrectomy, cryotherapy), radical nephrectomy, surveillance
24
Q

What are the indications for nephron sparing surgery?

A
  • single kidney
  • CKD
  • CV risk factors
  • pT1a tumours
25
Q

What is the treatment for metastatic renal cell carcinoma?

A

tyrosine kinase inhibitors

26
Q

Describe the risk factors for testicular cancer

A
  • age (20-45y)
  • cryptorchidism (absence of at least 1 testicle from scrotum)
  • HIV
  • Caucasian
27
Q

Describe the clinical presentation and investigation of testicular cancer

A
  • painless lump
  • scrotal US
  • look for tumour markers (alpha fetoprotein, beta hCG, LDH)
28
Q

Describe the classification of testicular tumours

A
  • germ cell (most common) = seminoma, teratoma, mixed, yolk sac
  • stromal (10% malignant) = leydig, sertoli
29
Q

Describe the treatment of testicular cancer

A
  • radical orchiectomy
  • chemotherapy
  • para-aortic nodal radiotherapy
  • retroperitoneal lymph node dissection
30
Q

Describe the risk factors for penile cancer

A
  • HPV
  • smoking
  • premalignant lesions
31
Q

Describe the treatment for penile cancer

A
  • circumcision
  • topical CO2/5FU
  • penectomy +/- reconstruction
  • lymphadectomy
  • chemo-radiotherapy

MBChB3 (100 decks)

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