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RENAL PATHOLOGY > Urothelial and Renal Cancers > Flashcards

Urothelial and Renal Cancers Flashcards

1
Q

Urethelial cancers affect what?

A

Bladder to collecting system

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2
Q

What is the most common site for urothelial tumours?

A

Bladder (90%)

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3
Q

What is the most common type of cancer of the bladder?

A

Transitional cell carcinoma

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4
Q

Squamous cell carcinoma of the bladder is associated with what?

A

Schistosomiasis endemic regions

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5
Q

What are the risk factors for TCC of the bladder?

A

Smoking
Aromatic amines
p53
Rb

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6
Q

What are the risk factors for SCC of the bladder?

A 
Schistosomiasis
Chronic cystitis
Cyclophosphamide therapy
Pelvic radiotherapy 
Adenocarcinoma
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7
Q

What are the typical presenting features of bladder cancer?

A 
Painless visible haematuria 
(frank or microscopic) 
Metastatic symptoms
Recurrent UTI
Storage bladder problems
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8
Q

Storage bladder problems are suggestive of what?

A

Carcinoma in situ

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9
Q

What are storage bladder symptoms?

A 
Dysuria 
Frequency
Nocturia
Urgency +/- urge incontinence
Bladder pain
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10
Q

How should haematuria be investigated?

A 
Urine culture 
Cystourethroscopy
Upper tract imaging
Urine cytology 
BP
U+E
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11
Q

How should frank haematuria be investigated?

A

Flexible cystourethroscopy within 2 weeks
IVU
USS
Urine Cytology

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12
Q

What is the risk associated with frank haematuria?

A

> 50y - 25-35% risk malignancy

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13
Q

How should dipstick haematuria be investigated?

A

Flexible cystourethroscopy within 4-6 weeks

USS

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14
Q

What is the risk associated with dipstick haematuria?

A

> 50y - 5-10% risk malignancy

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15
Q

How are urothelial tumours diagnosed?

A

IVU and USS

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16
Q

How are bladder tumours staged?

A

Cytoscopy and endoscopic resection (TURBT)
CT/MRI
Bone scan
CTU for upper tract TCC

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17
Q

How are bladder tumours staged?

A 
TNM
T stage of whether muscle  invasive or not
TCC grading 
G1-->G3
Well --> poorly differentiated
Carcinoma in situ
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18
Q

How is bladder cancer treated?

A

Based on site and staging

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19
Q

How are low grade non-muscle invasive tumours treated?

A

Endoscopic resection and intravesical chemotherapy (mitomycin C)
Prolonged endoscopic followup

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20
Q

How are repeat low grade non-muscle invasive tumours treated?

A

Prolonged intravesical chemotherapy

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21
Q

How are high grade non-muscle invasive tumours treated?

A

Endoscopic resection

Intravesical BCG therapy

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22
Q

How are muscle invasive bladder tumours in men treated?

A 
Neoadjuvant therapy 
Radical radiotherapy
Radical cystoprostatectomy
Extended lymphadenectomy 
Urinary diversion
23
Q

How are muscle invasive bladder tumours in men treated?

A 
Neoadjuvant therapy 
Radical radiotherapy
Radical pelvic exenteration with urethrectomy 
Extended lymphadenectomy 
Urinary diversion
24
Q

What prognosis is associated with bladder cancer?

A

Depends on stage, grade, size, spread, presence of CIS
Non-invasive low grade 90% 5y
Invasive high grade 50% 5y

25
What are the main symptoms of Upper tract TCC?
Frank haematuria Unilateral uretereic obstruction Flank - loin pain Symptoms of metastatic disease
26
What are the investigations for Upper tract TCC?
CT-IVU / IVU Urine cytology Ureteroscopy and biopsy
27
Upper tract TCC most commonly affect what?
Renal pelvis/collecting duct
28
How do Upper tract TCCs tend to appear?
High grade, unilateral, multifocal | High risk local recurrece
29
How are most Upper tract TCCs treated?
Nephro-ureterectomy
30
What are the indications for nephron-sparing endoscopic treatment in Upper tract TCC?
``` Absolute: Bilateral disease Unfit Relative: Unifocal Low grade ```
31
What are the common benign tumours of the kidney?
Oncocytoma | Angiomyolipoma
32
What is the commonest adult renal malignancy?
Renal adenocarcinoma
33
Where to renal adenocarcinomae tend to arise?
Proximal tubules
34
What are the histological subtypes of renal adenocarcinoma?
clear cell (85%) papillary (10%) chromophobe (4%) Bellini type ductal carcinoma (1%)
35
What are the risk factors for renal adenocarcinoma?
``` FH: von hippel-lindao, familial clear cell RCC, hereditary papillary RCC Smoking Anti-hypertensives Obesity ESRD Acquired renal cystic disease ```
36
How do renal adenocarcinoma typically present?
Asymptomatic (50%) Flank pain, mass, haematuria (10%) Paraneoplastic syndrome (30%) Metastatic disease (30%)
37
Where do renal adenocarcinoma typically spread?
Bone Brain Lungs Liver
38
How do paraneoplastic syndromes typically present?
``` Anorexia Cachexia Pyrexia Hypertension Hypercalcaemia Abnormal LFTs Anaemia Polycythaemia ```
39
What is a stage T1 renal adenocarcinoma?
Tumour <7cm confined within renal capsule
40
What is a stage T2 renal adenocarcinoma?
Tumour >7cm confined within renal capsule
41
What is a stage T3 renal adenocarcinoma?
Local extension outside capsule a - adrenal/peri-renal fat b - renal vein or IVC below diaphragm c - In IVC above diaphragm
42
What is a stage T4 renal adenocarcinoma?
Invades beyond Gerota's fascia (renal fascia)
43
How is renal adenocarcinoma investigated?
``` CT scan U+E FBC LFT USS DMSA + MAG-3 assess split function ```
44
How are T1/2 renal adenocarcinoma treated?
T1/2 - laparoscopic radical nephrectomy | Even with major venous invasion
45
How are metastatic renal adenocarcinoma treated?
Palliative cytoreductive nephrectomy
46
Why are other therapies less used in renal adenocarcinoma?
RCC are radioresistant, chemoresistant
47
What medical therapies are used in renal adenocarcinoma?
Multitargeted receptor tyrosine kinase inhibitors Interferon alpha Interleukin 1
48
What is the prognosis of T1 renal adenocarcinoma?
95% at 5y
49
What is the prognosis of T2 renal adenocarcinoma?
90% at 5y
50
What is the prognosis of T3 renal adenocarcinoma?
60% at 5y
51
What is the prognosis of T4 renal adenocarcinoma?
20% at 5y
52
What is the prognosis of N1/2 renal adenocarcinoma?
20% at 5y
53
What is the prognosis of M1 renal adenocarcinoma?
Median survival 12-18mo

RENAL PATHOLOGY (16 decks)

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