urological malignancy

Question 1

hematuria

Answer 1

• Macroscopic
– Visible – preferred term
– Frank

• Microscopic (occult)
– Dipstix
– Urine microscopy
– Non-visible haematuria – preferred term
– Symptomatic versus non-symptomatic

Question 2

diseases of the kidney

Answer 2

Question 3

haematuria examination

Answer 3

• Examination
• General examination
• Blood pressure
• Abdomen
• External genitalia
• Rectal examination of the prostate
• Vaginal examination
• Test the urine (dipstix for protein/blood/glucose)

Question 4

guidlines with haem

Answer 4

Question 5

haematuria

Answer 5

• Investigations
• Urine microscopy and culture
• Urine cytology
• Renal function (U+E’s, creatinine, eGFR)
• Imaging
– Ultrasound and/ or
– Intravenous urogram and/or
– CT scan
• Cystoscopy

Question 6

types of bladder cancer

Answer 6

TYPES
Transitional Cell Tumour
Squamous Cell Tumour (Chronic irritation, stones)
Adenocarcinoma (Urachal remnant)

Question 7

aetiology of bladder cancer

Answer 7

• Dyes, chemicals, aniline compounds.
• Rubber, cable and plastic industry,
hairdresser
• Drugs, Cyclophosphamide
• Smoking
• Schistosomiasis. (SCC)

Question 8

bladder cancer presentation

Answer 8

Haematuria
Cystitis
Renal failure
Other

Question 9

spread of cancer

Answer 9

SPREAD:
Direct
Urine-bourne
Lymphatic
Haematogenous

Question 10

stagin bladder cancer

Answer 10

STAGING
Cystoscopy
Examination under anaesthetic
Histopathology
For muscle invasive disease
CT scan chest/abdomen/pelvis
MRI pelvis
Bone scan

Question 11

bladdr cancer treatment

Answer 11

SUPERFICIAL
Telescopic Control
Intravesical Chemotherapy
Intravesical Immunotherapy (BCG vaccine)

MUSCLE INVASIVE DISEASE
Surgical Removal following neoadjuvant chemotherapy
Radiotherapy following neoadjuvant chemotherapy

METASTATIC DISEASE
Chemotherapy
Radiotherapy
Palliative Treatment

you can remove the bladder with surgery and attach the urethters to the colon (ileal loop diversion “69” technique

Question 12

bladder tyoe and treatmenr

Answer 12

Squamous Cell Cancer
Surgical
Treatment

Adenocarcinoma

Question 13

transitional cell tumour

Answer 13

Transitional Cell Tumour can affect the rest of the
urothelium from kidney to urethral meatus

Question 14

renal tumours

Answer 14

Adults: Renal cell carcinoma
Angiomyolipoma
Oncocytoma
(Liposarcoma)
(Lipoma)

Children: Wilms’ tumour
(Neuroblastoma)

Question 15

renal cell CARCINOMAS

Answer 15

Names: Grawitz tumour (Grawitz 1883)
Clear cell carcinoma
Renal cell carcinoma
Adenocarcinoma

Question 16

renal cel carcinoma

Answer 16

Aetiology:
Few factors identified
Familial
Hereditary (von Hippel-Lindau)
(tuberous sclerosis)
Smoking

Question 17

renal cell carcinoma present with

Answer 17

Presentation: Haematuria
Loin pain
Abdominal pain
Incidental – USS, CT
Metastases
(Varicocoele)

Question 18

non met effects of carcinoma

Answer 18

Non-metastatic effects:
Polycythemia (erythropoietin)
Hypercalcaemia (parathyroid hormone)
Hypertension (renin)
Fever
Anaemia
Abnormal LFT’s
Gastrointestinal symptoms (GUT endocrine
hormones)
Amyloid

Question 19

carcinoma effects

Answer 19

Investigations: FBC
Renal function
IVP
USS
CT scan chest/abdomen
(Bone scan)

Question 20

where carcinoma mets to`

Answer 20

Routes of spread: Lymphatic
Haematogenous
To: Pulmonary 75%
Skeletal 41%
Brain 13%
Liver 10%
Skin 9%
Other 17%

Question 21

carcinoma treatment

Answer 21

Treatment: Surgery is the only effective treatment
Radical/partial nephrectomy
VEGF Inhibitors increasing role
(vascular endothelial growth factor)
(Endocrine treatment)
(Immunothreapy)
(Chemotherapy)
(Radiotherapy)

Question 22

prostate bph sign

Answer 22

Symptoms of an enlarged prostate include
Poor flow
Incomplete bladder emptying
Nocturia
Increased frequency
Most men who have these symptoms do NOT have cancer

Question 23

bph treament

Answer 23

• No treatment
• Medical therapy with drugs
• Non invasive “surgery”
–Energy sources to destroy tissue
• Surgery
–Transurethral incision/resection
–Laser ablation/resection
–Open surgery

Question 24

symptoms of prostate cancer

Answer 24

• No symptoms – routine blood test (Prostate Specific Antigen)
• Urinary symptoms (similar to benign enlargement)
• Symptoms from cancer spread
Kidney problems
Bone problems

Question 25

psa?

Answer 25

• All men have circulating levels of PSA
• Normal ranges?
– <4ng/ml
– <age></age> • Age 45 up to 70
– <3ng/ml in the context of screening
• 11% of men have elevated PSA
– 3-4 of whom will have cancer
• The higher the PSA the greater chance
of prostate cancer being present

Question 26

symptoms of prostate cancer

Answer 26

• No symptoms – routine blood test (Prostate Specific
Antigen)
• Urinary symptoms (similar to benign enlargement)
• Symptoms from cancer spread
Kidney problems or bone problems

Question 27

staging of prostate cancer?

Answer 27

• Localised
–Organ confined - T1, T2
– Locally advanced T3

• Metastatic
–Lymph nodes
–Bone

•Staging based on
–Clinical examination
–PSA level
–MRI
–Bone scan

Question 28

prostate cancer treatment?

Answer 28

• Surveillance Programs/ Watchful Waiting
• Curative treatments of localised prostate cancer
–Surgery
–Radiation treatment +/- hormone therapy

• Symptomatic treatment
–Hormone therapy
–Surgery
–Radiotherapy
–Chemotherapy
–Others

Question 29

problems with prostte cancer treatment

Answer 29

• Curative treatments of localised prostate cancer
–Surgery
• Surgical complications
• Incontinence
• Impotence
–Radiation treatment +/- hormone therapy
• Acute problems
• Late problems (Bowel/bladder/impotence)
• Second malignancies
• Symptomatic treatment
– Chemotherapy
– Hormone therapy (medical castration)
• Male menopause