Urooncology Flashcards
What are the risk factors of prostate cancer?
- age (>65)
- familial and genetic factors (BRCA2, PTEN and TP53)
- hormones
- race (Afro-Carribean)
- geography (western)
What is the clinical presentation of prostate cancer?
Local:
- often asymptomatic (or raised PSA in screening)
- painful or slow micturition
- UTI
- haematuria
- urinary retention (anuria, uraemia)
- lymphoedema
Metastatic:
- bone pain
- renal failure
Describe the pathology of prostate carcinoma
- 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
Describe the TNM staging of prostate cancer
- 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
What is PSA and what does it do?
- serine protease secreted into seminal fluid
- liquifies seminal coagulation to hydrolyse semenogelins allowing release of sperm
- small amount released into circulation
What states will cause a rise in PSA?
- age
- size
- cancer
- inflammation, infection etc
What is the treatment of localised prostate cancer?
- watch and wait
- surveillance
- radiotherapy (external beam, conformal, brachytherapy)
- cryotherapy/HIFU
- TURP if symptomatic (surgical resection)
Describe the metastatic complications of prostate cancer and the signs of it
- spinal cord compression: urological emergency, severe pain, retention, constipation
- ureteric obstruction: anorexia, weight loss, raised creatinine
What is the treatment for advanced prostate cancer?
- androgen ablation therapy (medical castration - LHRH analogue) or surgical (orchidectomy)
- chemotherapy
- TURP for symptoms
- radiotherapy
What are the risk factors for bladder cancer?
- age (80+)
- race (white)
- environmental carcinogens
- chronic inflammation (stones, infection, long-term catheters etc.)
- drugs (eg. phenacetin, cyclophosphamide)
- pelvic radiotherapy
Describe the presentation and investigation of bladder cancer
- painless frank haematuria
- some with microscopic haematuria
- all require cystoscopy, renal US (kidney, urethra and bladder)
Describe the pathology of bladder cancer
- majority = transitional cell cancer (superficial 75% and invasive 25%
- squamous carcinoma
- adenocarcinoma
- secondary malignancies
Describe the treatment of bladder cancer
- urgent TURBT (surgical resection of tumour)
- CT intravenous urogram (look for upper tract involvement in renal pelvis)
- bimanual exam
- IV mitomycin to reduce recurrence
How are superficial bladder tumours treated to prevent recurrence?
- 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
How is bladder cancer with muscle involvement treated?
- radical cystectomy or radiotherapy
- if widespread or multifocal radiotherapy not best choice
- Neo-adjuvant chemo
What is involved in a radical cystectomy?
- bladder and prostate/uterus removed
- urine diverted into ideal conduit or orthotropic neobladder (rare)
How is metastatic bladder cancer treated?
- often pulmonary metastasis
- MVAC chemo = methotrexate, vinblastine, doxorubicin, cisplatin (highly toxic)
- gemicitobine/docetaxel
What are the risk factors for renal cell carcinoma?
- smoking
- obesity
- hypertension
- acquired renal cystic disease
- haemodialysis
- genetics
Describe the clinical presentation of renal cell carcinoma
- 80% incidental
- systemic symptoms (fever, night sweats, weight loss)
- haemoptysis
- mass, pain, haematuria
- varicocele
- lower limb oedema
- paraneoplastic syndrome
Describe the associations of paraneoplastic syndromes with renal cell carcinoma?
- polycythaemia (increased EPO)
- hypercalcaemia (PTH-like substance, osteolytic hypercalcaemia)
- hypertension (renin)
- deranged LFTs (Stauffer syndrome from hepatotoxic tumour products)
Describe the histology of renal cell carcinoma
- clear cell (80%) = vascular, granular and clear with lipids
- papillary (10%) = solid and multifocal
- chromophore (5%) = large, polygonal
- collecting duct and medullary cell (rare)
Describe the staging of renal cell carcinoma
- 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
Describe the treatment of renal cell carcinoma
- 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
What are the indications for nephron sparing surgery?
- single kidney
- CKD
- CV risk factors
- pT1a tumours
What is the treatment for metastatic renal cell carcinoma?
tyrosine kinase inhibitors
Describe the risk factors for testicular cancer
- age (20-45y)
- cryptorchidism (absence of at least 1 testicle from scrotum)
- HIV
- Caucasian
Describe the clinical presentation and investigation of testicular cancer
- painless lump
- scrotal US
- look for tumour markers (alpha fetoprotein, beta hCG, LDH)
Describe the classification of testicular tumours
- germ cell (most common) = seminoma, teratoma, mixed, yolk sac
- stromal (10% malignant) = leydig, sertoli
Describe the treatment of testicular cancer
- radical orchiectomy
- chemotherapy
- para-aortic nodal radiotherapy
- retroperitoneal lymph node dissection
Describe the risk factors for penile cancer
- HPV
- smoking
- premalignant lesions
Describe the treatment for penile cancer
- circumcision
- topical CO2/5FU
- penectomy +/- reconstruction
- lymphadectomy
- chemo-radiotherapy
