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UROLOGY & RENAL phase 1b > 1b Urological Cancers and BPH > Flashcards

1b Urological Cancers and BPH Flashcards

1
Q

What are the risk factors for kidney cancer?

A

Smoking, renal failure and dialysis, obesity, hypertension

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2
Q

Which condition leads to a genetic predisposition to kidney cancer?

A

Von Hippel-Lindau

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3
Q

What is the most common type of kidney cancer?

A

Adenocarcinoma - renal cell carcinoma

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4
Q

What is the most common symptom which might suggest Kidney Cancer?

A

Painless, visible Haematuria

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5
Q

Which investigations should be done if painless, non visible haematuria was present?

A

Flexible cystoscopy
CT urogram
Renal Function

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6
Q

What investigations should be done is persistent non-visible haematuria was present?

A

Flexible cystoscopy
US KUB

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7
Q

What investigations should be done if kidney cancer is suspected?

A

CT renal triple phase
Staging CT chest
Bone scan if symptomatic

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8
Q

What are the main clinical features of Kidney Cancer?

A

Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies

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9
Q

What are some additional features of renal cell carcinoma?

A

Loin pain
Palpable mass
Metastatic disease symptoms –bone pain, haemoptysis
Palpable bladder lesions
Penile Mass – rectal exam to assess the size of the cancer

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10
Q

What is the grading system used for kidney cancer?

A

Fuhrman grade

1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated

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11
Q

Describe the criteria for the TMN staging of RCC?

A

T1 – Tumour ≤ 7cm
T2 – Tumour >7cm
T3 – 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 regional LN
M1- distant met

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12
Q

What is the gold standard for kidney cancer management?

A

Gold standard is excision either via:
Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)
Radical Nephrectomy

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13
Q

What treatment is offered to patients with kidney cancer, but small tumours and unfit for surgery?

A

Cryosurgery - Freeze

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14
Q

What treatment can be given to patients with metastatic kidney cancer?

A

Receptor tyrosine Kinase Inhibitors

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15
Q

What are the risk factors for Bladder cancer?

A

Smoking, occupational exposure( aromatic hydrocarbons), chronic inflammation of bladder (bladder stones, schistosomiasis, long term catheter), drugs (cyclophosphamide), Radiotherapy

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16
Q

What is the most common type of bladder cancer?

A

Transitional cell carcinoma

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17
Q

Which parasite can cause bladder cancer?

A

schistosomiasis

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18
Q

What is the main clinical feature of bladder cancer?

A

Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies

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19
Q

What are the additional features of bladder cancer?

A

Suprapubic pain
Lower urinary tract symptoms and UTI
Metastatic disease symptoms – bone pain, lower limb swelling

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20
Q

What investigations should be done if the patient has painless visible haematuria?

A

Flexible cystoscopy
CT urogram
Renal function

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21
Q

What investigations should be done if the patient has persistent visible haematuria?

A

Flexible cystoscopy
US KUB

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22
Q

At what point would you state staging investigations for bladder cancer?

A

If the biopsy has proven to invade the muscle - then start staging investigations

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23
Q

What classification system is used for bladder cancer?

A

WHO classification
G1 = well differentiated
G2 = moderate differentiated
G3 = poorly differentiated

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24
Q

Describe the TMN staging for bladder cancer?

A

TNM staging of Bladder cancer
Ta – non invasive papillary carcinoma
Tis – carcinoma in situ
T1 – invades subepithelial connective tissue
T2 – invades muscularis propria
T3 – invades perivesical fat
T4 – prostate, uterus, vagina, bowel, pelvic or abdominal wall
N1 – 1 LN below common iliac birufication
N2 - >1 LN below common iliac birufication
N3 – Mets in a common iliac LN
M1- distant mets

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25
Q

What technique is used to remove bladder tumours?

A

A transurethral resection of bladder lesion uses heat to cut out all visible bladder tumour.

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26
Q

What is the management protocol for bladder cancer if it is non muscle invasive?

A

Non Muscle Invasive

  • If low grade and no CIS (carcinoma in situ) then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG
27
Q

What is the management protocol for bladder cancer which is muscle invasive?

A

Cystectomy
Radiotherapy
+/- chemotherapy
Palliative treatment

28
Q

What type of cancer is most prostate cancer?

A

Adenocarcinoma

29
Q

What are the risk factors for prostate cancer?

A

Increasing age, western nations, ethnicity

30
Q

In which other conditions is PSA raised in?

A

Inflammation eg UTI, Prostatitis and Benign Prostate Hyperplasia

31
Q

What is PSA?

A

enzyme which liquefies the ejaculate, and is used as a marker for prostate cancer

32
Q

If PSA is high, what is done to confirm next steps of treatment?

A

Multiparametric MRI before biopsy

33
Q

What is the method of biopsy done for the prostate?

A

Trans perineal prostate biopsy

34
Q

Why are trans perineal prostate biopsies prefered over transrectal?

A

less risk of infection and able to sample all areas of the prostate.

35
Q

What is the benefit of the multiparametric MRI?

A

Allows density of the PSA to be established, as sometimes the Prostate might just be enlarged in which case the PSA would be raised regardless

36
Q

What is the score used to grade prostate cancer?

A

Gleason score

37
Q

What are the levels of gleason score?

A

Since multifocal two scores based on level of differentiation

2-6 = Well differentiated
7 = Moderately differentiated
8 – Poorly differentiated

38
Q

What are the TNM stages for 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 (pelvis)
M1a- non regional LN
M1b- bone
M1x- other sites

39
Q

What is the management of prostate cancer in patients who are young and fit, and have high grade cancer?

A

Radical prostatectomy/Radiotherapy

40
Q

What is the management of patients who have low grade cancer and are young and fit?

A

Active surveillance (regular PSA, MRI and Bloods)

41
Q

What should PSA levels be post prostectomy?

A

Post prostatectomy – monitor PSA ( should be undetectable or <0.01ng/ml). If >0.2ng/ml then relapse

42
Q

What is the management plan in a patient with prostate cancer who is old / unfit, and has high grade cancer?

A

Hormone therapy - androgen replacement

43
Q

What is the management of prostate cancer if old and unwell, with low grade cancer?

A

Watchful waiting with regular PSA testing

44
Q

Why might bladder function be affected in a prostectomy?

A

The prostate contains the proximal sphincteric unit, which controls some degree of urinary continence. Prostatectomy removes the proximal urethral sphincter and there is a risk of inadvertent damage to the cavernous nerve to the prostate (which provides neural innervation to the bladder and urethra) resulting in bladder function being affected(3).

45
Q

What happens to urethral length in a prostectomy?

A

Moreover, urethral length changes during the operation which can also affect continence

46
Q

Damage to what structure causes erectile dysfunction in a prostectomy?

A

Cavernous nerve

47
Q

Which muscle does a prostectomy remove?

A

proximal urethral sphincter

48
Q

What does the cavernous nerve innervate?

A

Bladder and urethra

49
Q

What are the three broad classifications of testicular tumours?

A

Germ cell tumour
Sex cord tumours
Miscellaneous

50
Q

What are the three most common types of testicular tumours?

A
  1. Seminoma
  2. Spermatocytic seminoma
  3. Teratoma differentiated
51
Q

What is the difference between stage 1A, 1B and 1S testicular cancers?

A

1A - patients have tumours limited to testis and epididymis, no vascular or lymphatic involvement and no signs of metastasis

1B - more locally invasive primary tumour, but no sign of metastatic disease

1S - persistently elevated serum tumour marker levels, indicating subclinical metastatic disease

52
Q

What is AFP?

A

Alpha feto-protein - serum tumour marker

53
Q

In which situations is AFP elevatd?

A

Elevated in patients with yolk sac component within a teratomatous germ cell tumour

54
Q

Where is AFP usually synthesized?

A

normally synthesised by fetal yolk sac, liver , intestine

55
Q

What are the three main serum tumour markers?

A

AFP
beta sub unit of HCG
lactate dehydrogenase (LDH)

56
Q

What cells secrete HCG?

A

Secreted by placental syncitiotrophoblastic cells

57
Q

What cancers produce HCG?

A

choriocarcinomas

58
Q

What is LDH a marker for?

A

general tumour marker

59
Q

Which investigations are done for testicular cancer?

A

Abdominopelvic CT
Chest CT
Bone Scan / MRI

60
Q

What is radical Orchidectomy?

A

Removal of the testes through the abdominal wall

61
Q

What are the pathological prognostic factors in stage 1 disease (testicular cancer)?

A

1.Seminoma
- tumour size (>4cm)
- rete invasion (stromal)

  1. Non-seminomatous tumours (NSGCT)
    - lymphovascular invasion
    - presence (and extent) of embryonal carcinoma
62
Q

What are the symptoms of penile cancer?

A

Inability/ difficulty / pain on retracting foreskin (phimosis – partial/ complete)

Spraying of stream (meatal stenosis)

Obstructive LUTS (urethral stricture)

Association with penile cancer

63
Q

What is important to examine for when considering penile cancer?

A

regional inguinal lymphadenopathy

UROLOGY & RENAL phase 1b (7 decks)

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