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My Cards- Urinary > Week 10 Malignancy of the Urinary Tract > Flashcards

Week 10 Malignancy of the Urinary Tract Flashcards

1
Q

what are some of the risk factors of Prostate cancer?

A
  • increased age
  • family history- increased 4x risk if a first degree relative diagnosed before age of 60, also BRCA2 gene mutation
  • ethnicity- black > white > asian
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2
Q

Is mass screening of Prostate cancer a good idea- why?

A

not recommended to screen for PSA (prostate specific antigen)- due to possibility of:

  • overdiagnosis
  • over- treatment
  • quality of life- co morbidities of established treatments
  • cost effectiveness
  • PSA may be raised due to- infection, inflammation or large prostate
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3
Q

how does prostate cancer usually present?

A

usual:

  • asymptomatic
  • urinary symptoms- benign enlargement of prostate/bladder, overactivity
  • bone pain- most common metastatic site

unusual:
- haematuria- advanced cancer

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4
Q

how is prostate cancer usually diagnosed?

A

digital rectal examination (DRE)- TRUS- transrectal ultrasound- allows guided biopsy of prostate
- check serum PSA

lower urinary tract symptoms (LUTS)- transurethral resection of prostate (TURP)

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5
Q

what factors affect the treatment choice of prostate cancer?

A

age
DRE- localised (T1/2), locally advanced (T3), advanced (T4)
PSA level
biopsies- gleason grading, extent
MRI scan and bone scan- nodal and visceral metastasis?

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6
Q

how is localised (T1/2) prostate cancer treated- established and developmental options?

A

established treatments:

  • surveillance- PSA every 6months
  • radical protatectomy- open- laparoscopic- robotic
  • radiotherapy- external beam, low dose rate brachytherapy- implant radioactive substance which releases it from within

developmental:

  • HIFU- high intensity flourescent ultrasound
  • primary cryotherapy- use of extreme cold
  • high dose brachytherapy
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7
Q

how is locally advanced prostate cancer (T3) treated?

A

surveilance
hormones
hormones with radiotherapy

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8
Q

describe the epidemiology of Prostate cancer- who affected

A

correlation with increased age- urinary symptoms, benign enlargement of prostate
most pts diagnosed are- asymptomatic, have localised disease, unlikely to die from it

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9
Q

how is metastatic prostate cancer treated/ managed?

A

NO CURE- maintain quality of life only
Hormones:
- surgical castration- removal of testes
- medical castration- now more common- LHRH agonist (LH releasing hormone)- removal of testosterone

Palliation:

  • single dose radiotherapy- for bone pain
  • bisphosphonates- for widespread bone pain- zoledronic acid
  • chemo
  • new treatments
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10
Q

How can haematuria be classified on presentation and how is this associated with the likelihood of having a urological malignancy?

A

visible haematuria- 20% find urological malignancy
non visible:
- symptomatic- dipstick dont need microscope- 5% find malignancy
- asymptomatic- found microscopically- 0.5% find malignancy

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11
Q

what would be the possible differential diagnosis of haematuria?

A

urological:

  • cancer- renal cell carcinoma (RCC), upper tract transitional cell carcinoma (TCC), bladder cancer, advanced prostate carcinoma
  • other- stones, infection, inflammation, large benign prostate hyperplasia

nephrological (glomerular):
- more common in young people- if have proteinuria, high BP- early glomerular disease

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12
Q

what would you want to ask in a history and expect to see in an examination of a pt with haematuria?

A

history- smoker, occupation, painful/painless, other LUTS, family history
examination- BP, abdominal mass, varicocele (varicous veins on scrotum), leg swelling (lymphedema), assess prostate by DRE (male)- size and texture

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13
Q

what investigations would you perform on a pt presenting with haematuria?

A

bloods- FBC, U&E
radiology- ultrasound of urinary tract
urine- culture and sensitivity, cytology
endoscopy- flexibly cystoscopy- allows exam of bladder lining and urethra via camera- shows bladder cancer

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14
Q

describe the epidemiology of bladder cancer- incidence, M:F ratio, common type, risk factors?

A
  • 4th most common cancer in males, 11th in females- presentation more advanced in females
  • M:F 2.5:1
  • decreasing incidence
  • 90% transitional cell carcinoma (TCC)
  • risk factors- smoking (X4), occupational exposure (rubber manufacture, painters, hairdressers etc), schistosomiasis (bilharzia)- chronic disease due to infection with blood flukes (squamous cell carcinoma (SCC)
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15
Q

what is the initial definitive treatment of bladder cancer?

A

trans urethral resection (TUR) bladder tumour (TURBT)

  • superficial TURBT
  • separate deep TUR of muscle
  • single intravesical dose of mitomycin C (chemo) into bladder- dont loose hair
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16
Q

what is the staging of bladder cancer?

A

75% superficial- no muscle invasion just epithelium and subepithelium -Ta or T1
5% only affect epithelium TI
20% muscle invasive- T2,3,4 - even with treatment 50% die within 5yr

17
Q

what further treatment options are there for different staged bladder cancer?

A

low risk non muscle invasive TCC (G1,G2, Ta)
- check bladder every few weeks- cystoscopies +/- intravesical chemo

high risk no muscle invasive TCC (G3, Tis, T1)
- check cystoscopies, intracesical immunotherapy

muscle invasive TCC

  • potentially curative- neoadjuvant chemo (chemo before surgery) + radical cystectomy (remove bladder) or radiotherapy
  • palliative- chemo/radiotherapy to reduce symptoms
18
Q

describe options of radial cystectomy

A

can remove whole bladder- ileal conduit- insert piece of detached bowel which opens onto skin surface- sticks out so that urine doesnt irritate skin
can reconstruct bladder from bowel in small number of cases

19
Q

what is the commonest type of renal parenchyma cancer?

A

renal cell carcinoma (RCC)

20
Q

describe the epidemiology of renal cell carcinoma- how common, M:F ratio, presentation, aetiology (causes)?

A 
8th most common cancer in UK- 95% of all upper urinary tract tumours
incidence and mortality increasing
M:F 3:2
30% metastatic on presentation 
causes- smoking (X2), obesity, dialysis
21
Q

describe the possible spread of renal cell carcinoma

A

lymph node metastasis
perinephric spread- into surrounding fat
IVC spread to right atrium- tract up IVC to RA

22
Q

what imaging is done to diagnose renal cell carcinoma?

A

ultrasound and CT to fully stage

23
Q

how are localised RCC treated- established and developmental treatments?

A

established:

  • surveillance- smaller tumours may be able to leave alone
  • radical nephrectomy- remove kidney- sometimes adrenal, upper ureter and surrounding fat also
  • partial nephrectomy- part of above

developmental:
- ablation

24
Q

how is metastatic RCC treated?

A

palliative- molecular therapies targeting angiogenesis are now first choice
- chemo and radio resistant

25
Q

describe the epidemiology of upper tract transitional cell carcinoma (TCC)- how common, aetiology (causes)

A

only 5% of all malignancies of upper urinary tract

causes- smoking, phenacetin abuse (painkiller), balkans nephropathy

26
Q

what is the likelyhood of a pt with bladder cancer developing cancer in the upper urinary tract?

A

5%

27
Q

what is the likelihood of a pt with upper urinary tract cancer developing bladder cancer?

A

40%

28
Q

what initial investigations would you do if you suspected upper tract transitional cell carcinoma (TCC)?

A
  • ultrasound- hydronephrosis- fluid buildup due to failed drainage
  • CT urogram- filing defect, ureteric stricture
  • retrograde pyelogram- contrast injected to show ureter and kidney - flows up in opposite direction to urine
  • ureteroscopy- biopsy, washing for cytology
29
Q

what is the standard treatment for upper tract transitional cell carcinoma (TCC)?

A

nephro- ureterectomy- kidney, fat, ureter, cuff of bladder

30
Q

Describe the bone metastasis of prostate cancer- what found, how?

A

slcerotic (osteoblastic)
hot spots on bone scan shown up
unlikely if PSA

My Cards- Urinary (13 decks)

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