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urinary cancers Flashcards

1
Q

What is epidemiology of kidney cancer?

A

Increasing incidence and mortality

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2
Q

What are the types of kidney cancer and how common are they?

A

Most common renal cell carcinoma (adenocarcinoma).
Then transitional cell carcinoma.
-Rest are other (sarcoma, wilms tumour etc)

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3
Q

What are risk factors for kidney cancer?

A

Smoking, obesity, hypertension, genetics, renal failure & dialysis

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4
Q

What are the clinical features of kidney cancers? What is the red flag?

A
  • Red flag is painless haematuria/persistent microscopic haematuria.
  • Other features of RCC are loin pain, palpable mass, metastatic disease symptoms (bone pain, haemoptysis)
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5
Q

What investigations do you do when painless visible haematuria?

A

Flexible cytoscopy, CT urogram, renal function tests.

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6
Q

What investigations do you do when persistent non-visible haematuria?

A

Flexible cytoscopy, US KUB

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7
Q

What investigations for suspected kidney cancer?

A

CT renal triple phase, staging CT chest, bone scan if symptomatic

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8
Q

How do you TNM stage a renal cell carcinoma?

A

T1: tumour less or equal to 7cm.
T2: tumour bigger than 7cm.
T3: tumour extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia
T4: tumour beyond perinephric fascia into surrounding structures
N1: met in single regional LN
N2: met in 2 or more regional lymph nodes
M1: distant met

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9
Q

What is the fuhrman grade in renal cell carcinoma?

A

1=well differentiated, 2=moderate differentiated, 3 & 4 poorly differentiated

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10
Q

What are different managements for kidney cancer?

A
  • Depends on ASA status, comorbidities, lesion classifcation.
    1. partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL (von hippel lindau), T1 tumours - up to 7cm)
    2. radical nephrectomy.
    3. cryosurgery (small tumours and unfit for surgery)
    3. receptor tyrosine kinase inhibitors (in metastatic disease)
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11
Q

What is epidemiology of bladder cancer?

A

Incidence & mortality declining

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12
Q

What are types of bladder cancer and how common are they?

A

Most are transitional cell carcinoma (urothelial cells inside of bladder), some are squamous cell carcinomas (most where schistomoniasis is endemic), some adenocarcinomas

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13
Q

What are risk factors for bladder cancer?

A

Smoking, radiation, long-term cathetarization

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14
Q

What are clinical features of bladder cancer? red flag?

A
  • Painless haematuria/persistent microscopic haematuria red flag.
  • Bladder cancer - suprapubic pain, lower urinary tract symptoms, metastatic disease symptoms include bone pain & lower limb swelling
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15
Q

What are investigations for painless visible haematuria in bladder cancer?

A

Flexible cytoscopy, CT urogram, renal function

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16
Q

What are investigations for persistent microscopic haematuria?

A

Flexible cytoscopy, US KUB

17
Q

If biopsy proven muscle invasive in bladder cancer what investigations should be done?

A

Staging investigations

18
Q

How do you TNM stage bladder cancer?

A

Ta: non-invasive papillary carcinoma.
Tis: carcinoma in situ.
T1: invades sub-epithelial connective tissue.
T2: invades muscularis propria.
T3: invades perivesical fat.
T4: invades prostate, uterus, vagina, bowel, pelvic or abdominal wall.
N1: 1 LN below common iliac bifurcation.
N2: more than 1 LN below common iliac bifurcation.
N3 - metastases in common iliac LN.
M1: distant metastases

19
Q

What are the WHO classifications for differentiation in bladder cancer?

A

G1: well differentiated. G2: moderate differentiation. G3: poorly differentiated

20
Q

What is cytoscopy and transurethral resection of bladder lesion? What is risk and purpose?

A

Uses heat to cut out all visible bladder tumour.
Provides history and can be curative.
Can get bladder perforation.

21
Q

What is management protocol for bladder cancer?

A
  1. non-muscle invasive: if low grade & no carcinoma in situ consider cytoscopic suveillance +/- intravesicular chemotherapy/BCG.
  2. muscle invasive: cystectomy, radiotherapy +/- chemotherapy, palliative care
22
Q

What is epidemiology of prostate cancer?

A

Incidence rising, mortality rates declining

23
Q

What are types of prostate cancers?

A

most adenocarcinomas

24
Q

What are risk factors for prostate cancer?

A

Increasing age, western nations (scandinavian), ethnicity (african american)

25
Q

What are clinical features of prostate cancer?

A

Usually asymptomatic unless metastatic

26
Q

What are investigations for prostate cancer?

A
  1. PSA (prostate specific antigen): prostate specific but not prostate cancer specific (can be high in UTI, prostatis)
  2. MRI: imaging before biopsy testing. Risk assessment with multiparametric MRI before biopsy and MRI targeted biopsy more superior to previous biopsy testing (transrectal-ultrasonograph guided biopsy).
  3. trans-perineal prostate biopsy: systematic template biopsies of prostate. Used in most centres over transrectal biopsies as less risk of infection and more able to sample all areas of prostate
27
Q

How do you TNM stage a prostate cancer?

A

T1: non-palpable or visible on imaging.
T2: palpable tumour.
T3: beyond prostatic capsule into periprostatic fat.
T4: tumour fixed onto adjacent structure/pelvic side wall. N1: regional LN (pelvics).
M1a - non regional LN.
M1b.: bone.
M1x - other sites

28
Q

What is the gleason score and its outcomes?

A

Since multifocal, 2 scores based on level of differentiation (add):
2-6: well differentiated, 7 moderately differentiated 8- poorly differentiated
( nagme: first score gives you the most commonly seen ily x )

29
Q

What is management for prostate cancer depending on fitness/age and cancer agressiveness?

A
  1. if young and fit with high grade cancer - radical prostatectomy/radiotherapy. Young and fit but low grade cancer active surveillance (regular PSA, MRI, Bx). Post prostatectomy monitor PSA 6 monthly (should be undetectable or <0.01ng/ml, if >0.2ng/ml relapse).
  2. if old/unfit with high grade cancer/metastatic disease do hormone therapy. If low grade watchful waiting with regular PSA testing
30
Q

What are treatment side effects of prostate cancer?

A
  • Prostate contains proximal sphincter, prostatectomy removes proximal urethral sphincter and changes urethral length (urinary incontinence).
  • Risk of damage to cavernous nerves (innervation to bladder and urethra) causes erectile dysfunction and urinary incontinence
31
Q

Why shift towards imaging prior to biopsy testing?

A

Random biopsies of prostate were associated with under detection of high grade prostate cancer and over detection of low grade cancer.

32
Q

Treatment for prostatectomy caused urinary incontinence?

A

Build pelvic floor muscles via exercise. If fails artificial urinary sphincter device option

33
Q

Treatment for prostatectomy caused erectile dysfunction?

A

PDE5 inhibitors, prostaglandin E1 injections & penile prosthesis devices

BRS (81 decks)

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