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Urinary > Week 9 (not Glomerular Injury) > Flashcards

Week 9 (not Glomerular Injury) Flashcards

1
Q

Risk factors for prostate cancer

A

Increasing age
First degree relative diagnosed before age of 60
Afro-Caribbean > Caucasian > Asian

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2
Q

Why is there no screening for prostate cancer

A 
Over diagnosis 
Over treatment 
Not cost effective 
Poorer quality of life 
May have benign enlargement of prostate
PSA may be raised in inflammation/infection
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3
Q

Presentation of prostate cancer

A

Usual - asymptomatic (majority), voiding problems, overactive bladder, bone pain
Unusual - haematuria (advanced)

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4
Q

How is prostate cancer diagnosed

A

DRE and serum PSA used to assess whether a biopsy is needed

Transrectal ultrasound guided biopsy

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5
Q

How are lower urinary tract symptoms with prostate cancer treated

A

Transurethral resection of the prostate

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6
Q

What factors influence treatment of prostate cancer

A 
Age
Bone scan - sclerotic in bone 
DRE - T1/2 (nodules), T3 (very rough), T4 (rock hard)
Biopsy - Gleason grade 
PSA level
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7
Q

Treatment for localised established prostate cancer

A

Surveillance
Radical prostatectomy
Low dose brachytherapy (implanted beads)

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8
Q

Treatment for localised developmental prostate cancer

A 
High dose brachytherapy
High intensity focused ultrasound 
Primary cryotherapy (freeze prostate)
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9
Q

Treatment for locally advanced prostate cancer

A

Surveillance

Hormones (+/- radiotherapy)

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10
Q

Treatment for metastatic prostate cancer

A

Luteinising hormone releasing hormone agonist (eventually lowers LH so lowers testosterone)
Palliative - single dose radiotherapy, bisphosphonates, chemotherapy

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11
Q

Types of haematuria

A

Visible

Non-visible - symptomatic or asymptomatic

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12
Q

How is non visible haematuria detected

A

Microscopy

Urine dipstick

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13
Q

Differential diagnosis for haematuria

A 
Cancer (RCC, upper tract TCC, bladder, advanced prostate)
Glomerular injury
Stones
Infection
Inflammation
BPH
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14
Q

Important features of history in haematuria

A 
Occupation
Smoking
Family history
Pain
Other lower urinary tract symptoms
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15
Q

Things to look for in examination with haematuria

A 
BP
Abdominal mass
Varicocele - collection of veins in scrotum 
Leg swelling
DRE
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16
Q

Investigations for haematuria

A

Flexible cystoscopy
Blood - FBC and Us and Es
Urine culture
Ultrasound - hydronephrosis and kidney tumour

17
Q

Demographics of bladder cancer

A

2.5 times more likely in males

Usually more advanced in women

18
Q

What is the most common bladder cancer

A

Transitional cell carcinoma

19
Q

Risk factors for bladder TCC

A

Smoking
Occupational exposure to arylamines and polyaromatic hydrocarbons
Schistosomiasis

20
Q

Incidence of different bladder cancer stages

A

75% superficial - T1 or Ta
5% in situ - Tis
20% muscle invasive - T2-4

21
Q

Bladder cancer stages

A 
Tis - just in epithelium, not lumen
Ta - epithelium and lumen 
T1 - subethelial connective tissue (lamina propria)
T2 - into detrusor muscle
T3/4 - into perivesical fat
22
Q

Initial treatment for bladder cancer

A

Transurethral resection of the bladder cancer

23
Q

Treatment for low risk non muscle invasive bladder TCC

A

Check cystoscopies

Intravesical chemotherapy

24
Q

Treatment for high risk non muscle invasive bladder TCC

A

Check cystoscopies

Intravesical immunotherapy

25
Q

Treatment for muscle invasive bladder TCC

A

If curative - radical cystectomy, radiotherapy, chemotherapy
Palliative - chemotherapy or radiotherapy

26
Q

Types and incidence of upper urinary tract tumours

A

Renal cell carcinoma - 95%
Upper tract transitional cell carcinoma -
5%

27
Q

Risk factors of upper urinary tract cancers

A

RCC - smoking, obesity and dialysis

TCC - smoking, phenacetin abuse and Balkans nephropathy

28
Q

Demographics of renal cell carcinoma

A

Affects men 1.5 times more than women

29
Q

Where can RCC spread to

A

Subcapsular fat by perinephric spread
Right atrium via renal vein and IVC
Lymph nodes
Lungs - cannonball metastasis

30
Q

Treatment for localised established RCC

A

Surveillance
Radical nephrectomy - remove kidney, adrenal gland, surrounding fat, upper ureter
Partial nephrectomy

31
Q

Treatment for localised developmental RCC

A

Ablation - removal of tumour from surface via erosion

32
Q

Treatment for metastatic RCC

A

Palliative - molecular therapies targeting angiogenesis, immunotherapy

33
Q

Investigations for upper tract TCC

A

Ultrasound - hydronephrosis
CT urogram - filling defect or Ureteric stricture
Retrograde pyelogram (inject contrast into ureter)
Ureteroscopy - biopsy

34
Q

Treatment for upper tract TCC

A

Nephrourectomy - remove kidney, surrounding fat, ureter and bladder cuff

Urinary (6 decks)

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