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2nd Year > Tumours of urinary system and imaging > Flashcards

Tumours of urinary system and imaging Flashcards

1
Q

Where do malignant tumours of the lining transitional cell epithelium occur?

A

At any point from renal calyces to the tip of the urethra. Most common site - bladder - 90%

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2
Q

Bladder cancer - most common type of tumour is?

A

Transitional cell carcinoma (90% in UK)

Schistosomiasis (flatworm) is endemic, squamous cell carcinoma of bladder is the common tumour type.

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3
Q

Risk factors for Bladder cancer?

A

TCC:

  • smoking (40% cases)
  • aromatic amines
  • non-hereditary genetic abnormalities (TSG)

Squamous cell carcinoma:

  • Schistosomiasis
  • Chronic cystitis (long term catheter, bladder stone, recurrent UTI)
  • Cyclophosphamide therapy
  • pelvic radiotherapy

Adenocarcinoma
- Urachal

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4
Q

Presenting features of bladder cancer

A 
Most frequent presenting symptom:
- Painless visible haematuria
Haematuria may be 
- Frank
- Microscopic 
Occasionally:
Symptoms due to invasive or metastatic disease. 
Recurrent UTI
Storage bladder symptoms:
- dysuria, frequency,nocturne,urgency +/- urge incontinence. 
- bladder pain 
- if present, suspect CIS
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5
Q

Investigations of Haematuria

A

Urine culture:
- majority of painful haematuria = UTI

Upper tract imaging:
CT urogram (IVU)
US scan

Cystourethroscopy:
- commonest neoplastic cause is TCC bladder

Urine cytology
- limited use in dipstick haematuria

BP and U&E’s.

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6
Q

What is the risk of malignancy and what investigations are carried out for FRANK haematuria?

A

> 50 yrs - risk of malignancy -25-35%

  • Flexible cystourethroscopy within 2 weeks
  • CT urogram & USS
  • Urine cytology may also be useful (not very sensitive nor specific)
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7
Q

Risk of malignancy for Dipstick or microscopic haematuria and investigations carried out?

A

> 50 yrs - risk of malignancy = 5-10%

  • Flexible cystourethroscopy within 4-6 weeks
  • USS
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8
Q

How do you diagnose bladder cancer?

A

Cystoscopy and endoscopic resection. (TURBT)

EUA to assess bladder mass/thickening before and after TURBT

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9
Q

How do you investigate the staging?

A

Cross-sectional imaging (CT, MRI)
Bone scan if symptomatic
CTU for upper tract TCC

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10
Q

Treatment for bladder cancer

A

Endoscopic or radical

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11
Q

How do you classify bladder tumours?

A 
Grade
Stage of tumour 
- TNM classification 
- T stage: 
- non-muscle invasive 
- muscle invasive
  • Combined to describe TCC.
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12
Q

What are the grades of TCC?

A

G1 = Well diff. - commonly non-invasive
G2 = Mod.diff - often non-invasive
G3 = Poorly diff - often invasive
- Carcinoma in situ (CIS) - non-muscle invasive but VERY aggressive (hence treated differently)

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13
Q

T stage of Bladder TCC

A 
Tis
Ta
T1
T2a
T2b
T3a
T3b
T4a - prostate 
T4b
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14
Q

What does appropriate treatment depend on?

A
  • Site
  • Clinical stage
  • Histological grade of tumour
  • Patient age and co-morbidities
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15
Q
  1. What is survival for non- invasive low grade bladder TCC?
  2. Invasive, high grade bladder TCC?
A
  1. 90% 5 - year survival

2. 50% 5 - year survival

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16
Q

Treatment for Low grade non-muscle invasive bladder cancer

A

Ta or T1

  • endoscopic resection followed by single instillation of intravesical chemotherapy within 24hr.
  • consider prolonged course of chemo for repeated recurrences.
17
Q

Treatment for high grade non-muscle invasive or CIS

A

Very aggressive - 50-80% risk of progression to muscle invasive stage.
Intravesical BCG therapy.

18
Q

Treatment for muscle invasive bladder cancer?

A 
T2-T3 
- neoadjuvant chemo for local and systemic control; followed by:
Radical radiotherapy or
radical cystoprostatectomy.. 
Radical surgery.
19
Q

Upper Tract urothellia cancer presenting features

A

Main symptoms:

  • Frank haematuria
  • Unilateral ureteric obstruction
  • Flank or loin pain
  • Symptoms of nodal or metastatic disease:
  • bone pain, hypercalcaemia, lung, brain.
20
Q

Diagnostic investigations for UTUC

A

CT-IVU (shows filling defect)
Urine cytology
Ureteroscopy and biopsy

21
Q

Upper tract TCC where is it common and what is the treatment?

A

Renal pelvis or collecting system commonest.
Tumours often high-grade and multifocal on one side.

Treatment = endoscopically or segmental resection.
most treated by - Nephron-ureterectomy.

22
Q

What are the types of Renal tumours?

A

Benign: oncocytoma, angiomyolipoma

Malignant: renal adenocarcinoma 
- commonest adult renal malignancy
- most arise from proximal tubules 
Histology subtypes:
- clear cell (85%
- Papillary (10%)
- Chromophobe (4%) 
- Bellini type ductal carcinoma (1%)
23
Q

Risk factors of Renal adenocarcinoma

A 
Family history (autosomal dominant) 
Smoking 
Anti-hypertensive medication 
Obesity 
End - stage renal failure
Acquired renal cystic disease
24
Q

Renal adenocarcinoma presentation

A

Asymptomatic - 50%

Classic “triad” of flank pain, mass and haematuria - 10%

Paraneoplastic syndrome: 30%
- anorexia, pyrexia, hypertension, hypercalaemia, anemia.

Metastatic disease - 30%
- bone, brain, lung, liver

25
Q

TNM staging of renal cancer

A

T1 - tumour <7cm confined within renal capsule
T2 - tumour > 7cm and confined within capsule
T3 - Local extension outside capsule
T3a - into adrenal or peri-renal fat
T3b - into renal vein or IVC below diaphragm
T3c - Tumour thrombus in IVC extends above diaphragm
T4 - Tumour invades beyond Gerota’s fascia

26
Q

Investigations for renal adenocarcinoma

A

CT scan of abdomen and chest- staging and assesses contralateral kidney.
Bloods: U&E, FBC
US - cyst or tumour.

27
Q

Treatment for renal Adenocarcinoma

A

Surgical - radical nephrectomy - laparoscopic radical nephrectomy standards for T1.

28
Q

Prognosis for renal adenocarcinoma in terms of staging for 5 year survival.

A 
T1 - 95% 
T2 - 90%
T3 - 60% 
T4 - 20% 
N1 or N2 - 20%

M1 - median survival 12-18 months.

29
Q

When would we want to use renal imaging?

A
  • Renal colic and renal stone disease for diagnosis and follow up.
  • haematuria
  • suspected renal mass
  • UTIs
  • hypertension
30
Q

What are the different imaging techniques?

A
  • Plain film
  • Contrast studies - IVU, cystography.
  • Ultrasound +/- contrast
  • CT and CTU
  • MR and MRU
  • Isotope scans
  • PET-CT
31
Q

Advantages and Disadvantages of Plain films

A

+ cheap, readily available, functional and anatomical information (IVU)

  • Low sensitivity and specificity for urological diseases
  • radiation
32
Q

Advantages and disadvantages of US

A

+ cheap, readily available, no radiation, contrast not nephrotoxic, real time imaging

  • limited by body habits and gas, poor visualisation of ureters, operator dependent, no functional information.
33
Q

Advantages and disadvantages of CT

A

+ Imaging modality of choice for detection of renal stones, staging renal tumours, investigation of heamaturia.

  • Radiation dose
  • Cost
  • Contrast resolution less than MR
  • Contrast reaction and nephrotoxicity
34
Q

Advantages and disadvantages of MR

A

+ multiplayer imaging, excellent contrast resolution, imaging of urothelium without contrast injection

  • poor spatial resolution, poor detection of calcification and stones, Cost, contraindications and contrast reaction.
35
Q
  1. What is a MAG3 used for?

2. What is DMSA?

A
  1. Renal function and drainage.

2. Look for renal scarring

2nd Year (27 decks)

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