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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
Q

What are the main symptoms of Upper tract TCC?

A

Frank haematuria
Unilateral uretereic obstruction
Flank - loin pain
Symptoms of metastatic disease

26
Q

What are the investigations for Upper tract TCC?

A

CT-IVU / IVU
Urine cytology
Ureteroscopy and biopsy

27
Q

Upper tract TCC most commonly affect what?

A

Renal pelvis/collecting duct

28
Q

How do Upper tract TCCs tend to appear?

A

High grade, unilateral, multifocal

High risk local recurrece

29
Q

How are most Upper tract TCCs treated?

A

Nephro-ureterectomy

30
Q

What are the indications for nephron-sparing endoscopic treatment in Upper tract TCC?

A 
Absolute:
Bilateral disease
Unfit 
Relative:
Unifocal
Low grade
31
Q

What are the common benign tumours of the kidney?

A

Oncocytoma

Angiomyolipoma

32
Q

What is the commonest adult renal malignancy?

A

Renal adenocarcinoma

33
Q

Where to renal adenocarcinomae tend to arise?

A

Proximal tubules

34
Q

What are the histological subtypes of renal adenocarcinoma?

A

clear cell (85%)
papillary (10%)
chromophobe (4%)
Bellini type ductal carcinoma (1%)

35
Q

What are the risk factors for renal adenocarcinoma?

A 
FH: von hippel-lindao, familial clear cell RCC, hereditary papillary RCC
Smoking
Anti-hypertensives 
Obesity
ESRD
Acquired renal cystic disease
36
Q

How do renal adenocarcinoma typically present?

A

Asymptomatic (50%)
Flank pain, mass, haematuria (10%)
Paraneoplastic syndrome (30%)
Metastatic disease (30%)

37
Q

Where do renal adenocarcinoma typically spread?

A

Bone
Brain
Lungs
Liver

38
Q

How do paraneoplastic syndromes typically present?

A 
Anorexia 
Cachexia 
Pyrexia
Hypertension
Hypercalcaemia
Abnormal LFTs
Anaemia 
Polycythaemia
39
Q

What is a stage T1 renal adenocarcinoma?

A

Tumour <7cm confined within renal capsule

40
Q

What is a stage T2 renal adenocarcinoma?

A

Tumour >7cm confined within renal capsule

41
Q

What is a stage T3 renal adenocarcinoma?

A

Local extension outside capsule
a - adrenal/peri-renal fat
b - renal vein or IVC below diaphragm
c - In IVC above diaphragm

42
Q

What is a stage T4 renal adenocarcinoma?

A

Invades beyond Gerota’s fascia (renal fascia)

43
Q

How is renal adenocarcinoma investigated?

A 
CT scan 
U+E
FBC
LFT
USS
DMSA + MAG-3 assess split function
44
Q

How are T1/2 renal adenocarcinoma treated?

A

T1/2 - laparoscopic radical nephrectomy

Even with major venous invasion

45
Q

How are metastatic renal adenocarcinoma treated?

A

Palliative cytoreductive nephrectomy

46
Q

Why are other therapies less used in renal adenocarcinoma?

A

RCC are radioresistant, chemoresistant

47
Q

What medical therapies are used in renal adenocarcinoma?

A

Multitargeted receptor tyrosine kinase inhibitors
Interferon alpha
Interleukin 1

48
Q

What is the prognosis of T1 renal adenocarcinoma?

A

95% at 5y

49
Q

What is the prognosis of T2 renal adenocarcinoma?

A

90% at 5y

50
Q

What is the prognosis of T3 renal adenocarcinoma?

A

60% at 5y

51
Q

What is the prognosis of T4 renal adenocarcinoma?

A

20% at 5y

52
Q

What is the prognosis of N1/2 renal adenocarcinoma?

A

20% at 5y

53
Q

What is the prognosis of M1 renal adenocarcinoma?

A

Median survival 12-18mo

RENAL PATHOLOGY (16 decks)

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