Week 4 - E - Urological malignancies - RCC, benign & penis cancers Flashcards
What is the most common type of kidney cancer?
Renal cell carcinoma
Is renal cell carcinoma an adneo or squamous carcinoma?
It is an adenocarcinoma
What is a classic triad of features in renal cell carcinoma?
Haemeturia, flank pain and abdominal mass
Ultrasoun can be used to differentiate the tumour from what?
Cyst vs solid tumour
Vast majority of kidney lesions are benign as they are asymptomatic simple cysts – can have single or multiple benign cytss What is used for these?
Ultrasound or Contrast Ct - nephrographic phase shows cysts
Benign Blood vessels, fat, muscle What i this tumour known as?
Angiomyolipoma
What is used for diagnosis of an angiomyolipoma? Why can embolisms form from them?
Use a CT scan
They can haemorrhage and therefore bleed and then clot causing an embolism
Haemorrhage of the angiomyolipoma can occur that is confined to the perirenal space What is this syndrome known as?
This is known as Wunderlich’s syndrome -
Wunderlich syndrome is spontaneous, nontraumatic renal hemorrhage confined to the subcapsular and perirenal space.
It may be the first manifestation of a renal angiomyolipoma (AML)
What two cancers are aossicated with a cannonball metastases to the lungs?
Renal cell carcinoma and choriocarcinoma (testicular tumour)
How does a renal cell carcinoma present? (5 symptoms/signs at least)
Hameaturia
Flank pain
Abdominal mass
Weight loss
Anaemia
Hypertension
Renal cell carcinoma usually presents at ages 65-75 years What do you suspect if multifocal or bilateral renal cell carcinoma of a young patient?
VHL - von hiipel lindau syndrome -
hemangioblastomas, pheochromocytoma, renal cell carcinoma, pancreatic cysts – VHL gene mutation causing VHL
Why may a renal cell carcinoma present with a varicocele if it has invaded the renal vein?
This is because the spermatic vein cannot drain into the left renal vein therefore the veins on the testis become swollen and dilated
In renal cell carcinoma. what is used as diagnosis?
Ultrasound followed by a CT scan
Why are biopsies not very good at diagnosing renal cell carcinomas?
They have a high false negative
What type of CT scan is used in renal cell carcinoma?
Triple phase CT scan
What is the name for the staging of renal cell carcinomas?
Robson staging
Staging for renal cell carcinoma is done via robson staging What are the 4 common metastases?
Lung Liver Bone Brain
Stage 1 of the robson staging of renal cell carcinomas is confined with in the capsule What is stage 2?Term
tumour has spread to perinephric fat but has not invaded Gerota’s fascia (deep renal fascia)
At what robsons stage, does the RCC invade the renal vein?
Robson stage 3
What tumour stage is radical nephrectomy carried out?
Tumour stages 1 or 2
When a patient has metastatic disease, what is the measurement of performance status that is used before deciding on treatment?
The ECOG Scale of Performance Status is one such measurement.
What are potential drugs given for metastatic disease?
IL2 - interleukin 2
Interferon alpha tyrosine kinase inhibitors (sutinib)
What is stage 1 and stage 4 five year survival rate?
Stae 1 - 75% Stage 2- 50% Stage 3 - 35% Stage 4 - 5%
What is a bad prognostic sign for RCC?
Inasion into the renal vein
What are premalignant cutaneous lesions on the penis?
Bilantis xerotica obliterans and leukoplakia
Squamous cell carcinoma in situ - erythroplasia of queryat
Squamous cell carcinoma (of the penis) Malignant proliferation of squamous cells of penile skin Not common
Risk factors - what are the two main ones?
HPV type 16
Lack of circumcision - foreskin can act as a site of inflammation if not properly cleaned
If the squamous cell carcinoma in situ is on the prepuce alone, what is the treatment? If on other parts what drug is given?
Circumscion alone if confined to prepuce
5-fluorouracil
In a primary penil tumour , what investigation is carried out to check for corpus cavernosum invasion?
Ultrasound
What is the treatment for penis cancer?
Total or partial penectomy and radiotherapy if metastasised
What age does someone get a seminoma usually? What age for a teratoma?
Seminoma - usally 30-50s - measure placental alkaline phosphatase (PLAP)
Teratoma - usually 20-50s – 100% elevated HCG if trophoblastic, can measure alfafetoprotein (AFP) if yolk sac components
