Week 9 (not Glomerular Injury) Flashcards
Risk factors for prostate cancer
Increasing age
First degree relative diagnosed before age of 60
Afro-Caribbean > Caucasian > Asian
Why is there no screening for prostate cancer
Over diagnosis Over treatment Not cost effective Poorer quality of life May have benign enlargement of prostate PSA may be raised in inflammation/infection
Presentation of prostate cancer
Usual - asymptomatic (majority), voiding problems, overactive bladder, bone pain
Unusual - haematuria (advanced)
How is prostate cancer diagnosed
DRE and serum PSA used to assess whether a biopsy is needed
Transrectal ultrasound guided biopsy
How are lower urinary tract symptoms with prostate cancer treated
Transurethral resection of the prostate
What factors influence treatment of prostate cancer
Age Bone scan - sclerotic in bone DRE - T1/2 (nodules), T3 (very rough), T4 (rock hard) Biopsy - Gleason grade PSA level
Treatment for localised established prostate cancer
Surveillance
Radical prostatectomy
Low dose brachytherapy (implanted beads)
Treatment for localised developmental prostate cancer
High dose brachytherapy High intensity focused ultrasound Primary cryotherapy (freeze prostate)
Treatment for locally advanced prostate cancer
Surveillance
Hormones (+/- radiotherapy)
Treatment for metastatic prostate cancer
Luteinising hormone releasing hormone agonist (eventually lowers LH so lowers testosterone)
Palliative - single dose radiotherapy, bisphosphonates, chemotherapy
Types of haematuria
Visible
Non-visible - symptomatic or asymptomatic
How is non visible haematuria detected
Microscopy
Urine dipstick
Differential diagnosis for haematuria
Cancer (RCC, upper tract TCC, bladder, advanced prostate) Glomerular injury Stones Infection Inflammation BPH
Important features of history in haematuria
Occupation Smoking Family history Pain Other lower urinary tract symptoms
Things to look for in examination with haematuria
BP Abdominal mass Varicocele - collection of veins in scrotum Leg swelling DRE
Investigations for haematuria
Flexible cystoscopy
Blood - FBC and Us and Es
Urine culture
Ultrasound - hydronephrosis and kidney tumour
Demographics of bladder cancer
2.5 times more likely in males
Usually more advanced in women
What is the most common bladder cancer
Transitional cell carcinoma
Risk factors for bladder TCC
Smoking
Occupational exposure to arylamines and polyaromatic hydrocarbons
Schistosomiasis
Incidence of different bladder cancer stages
75% superficial - T1 or Ta
5% in situ - Tis
20% muscle invasive - T2-4
Bladder cancer stages
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
Initial treatment for bladder cancer
Transurethral resection of the bladder cancer
Treatment for low risk non muscle invasive bladder TCC
Check cystoscopies
Intravesical chemotherapy
Treatment for high risk non muscle invasive bladder TCC
Check cystoscopies
Intravesical immunotherapy
Treatment for muscle invasive bladder TCC
If curative - radical cystectomy, radiotherapy, chemotherapy
Palliative - chemotherapy or radiotherapy
Types and incidence of upper urinary tract tumours
Renal cell carcinoma - 95%
Upper tract transitional cell carcinoma -
5%
Risk factors of upper urinary tract cancers
RCC - smoking, obesity and dialysis
TCC - smoking, phenacetin abuse and Balkans nephropathy
Demographics of renal cell carcinoma
Affects men 1.5 times more than women
Where can RCC spread to
Subcapsular fat by perinephric spread
Right atrium via renal vein and IVC
Lymph nodes
Lungs - cannonball metastasis
Treatment for localised established RCC
Surveillance
Radical nephrectomy - remove kidney, adrenal gland, surrounding fat, upper ureter
Partial nephrectomy
Treatment for localised developmental RCC
Ablation - removal of tumour from surface via erosion
Treatment for metastatic RCC
Palliative - molecular therapies targeting angiogenesis, immunotherapy
Investigations for upper tract TCC
Ultrasound - hydronephrosis
CT urogram - filling defect or Ureteric stricture
Retrograde pyelogram (inject contrast into ureter)
Ureteroscopy - biopsy
Treatment for upper tract TCC
Nephrourectomy - remove kidney, surrounding fat, ureter and bladder cuff
