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Renal > renal, testicular and penile cancer > Flashcards

renal, testicular and penile cancer Flashcards

1
Q

describe oncocytoma

A 
benign
spherical, capsulated, brown/tan cloured
central scar on CT
hallmark = aggregates of eosinophilic cells
cells packed with mitochondria
spoke wheel pattern on CT
similar to chromophobe RCC on biopsy
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2
Q

how does oncocytome present?

A

loin pain
haematuria
often an incidental finding

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3
Q

how is oncocytoma managed?

A

same as RCC

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4
Q

what is angiomyolipoma associated with?

A

80% are sporadic in middle aged females

20% are associated with tuberous sclerosis (80% of tuberous sclerosis patients have angiomyolipoma)

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5
Q

angiomyolipoma pathology?

A

blood vessels
immature smooth muscle
fat (black shadowing on kidney)

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6
Q

features of tuberous sclerosis?

A 
facial angiofibromas
periungual fibromas
hypomelanotic macules
shagreen patches
multiple retinal nodular hamartoma
renal AMLs
subependymal nodule and astrocytoma
cardiac rhabdomyoma
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7
Q

how does angiomyolipoma present?

A 
loin pain
haematuria
mass
often incidental
wunderlich's syndrome occurs in 10% (massive retroperitoneal bleed)
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8
Q

investigation of angiomyolipoma?

A

US - bright echo pattern

CT - fatty tumour of low density

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9
Q

management of angiomyolipoma?

A

4cm is considered the cut off for needing treatment (<4cm does not need treatment)
elective = embolization/partial nephrectomy
emergency = embolization ; emergency nephrectomy

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10
Q

when is angiomyolipoma monitored?

A

in pre-menopausal women as it can increase in size during pregnancy and cause problems

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11
Q

describe renal cell carcinoma

A

an adenocarcinoma of the renal cortex believed to arise from proximal convoluted tube

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12
Q

featuers of RCC?

A

tan coloured
lobulated
solid
10-25% contain cysts

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13
Q

classification of renal cell carcinoma?

A

conventional clear cell (80%) - due to loss of VHL gene on short of chromosome 3
papillary (10-15%) - 40% are multifocal
chromophobe (5%)
collecting duct - rare, young patients, poor prognosis
medullary cell - young sickle cell patients, very poor prognosis

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14
Q

grading of renal cancer?

A

1-4

- grading = prognosis

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15
Q

staging of renal cancer?

A 
T1 = up to 7cm
T2 = >7cm confined to kidney
T3 = extends beyond kidney into renal vein, perinephric fat, renal sinus, IVC (more common on right side as shorter renal vein?)
T4 = beyond gerotas fascia into surrounding structure
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16
Q

risk factors for RCC?

A 
male 
smoking
renal failure and dialysis
obesity
hypertension
low socioeconomic status
asbestos
genetic (VHL, AD syndrome)
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17
Q

how does RCC present?

A 
haematuria
loin pain
mass
pyrexia of unknown origin
variocele
paraneoplastic syndrome (anaemia, polycthaemia, hypertension, hypoglycaemia, cushings, hypercalcaemia, gynaecomastia, staiffer's syndrome)
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18
Q

how can RCC cause variocele?

A

usually on the left
if cancer is in left renal vein, left gonadal vein drains into left renal so blockage causes back pressure and variocele in left testicle

19
Q

investigations in RCC?

A

US
CT of chest abdomen, pelvis for staging
FBC
renal and liver function

20
Q

treatment of RCC <3cm?

A

surveillance in elderly and unfit

ablation techniques in fit elderly and selected young patients

21
Q

treatment of RCC >3cm?

A 
partial nephrectomy (gold standard in young patient?)
radical nephrectomy (whole kidney removed - easier and safer surgery, quicker recovery time)
22
Q

management of large tumours?

A

radical nephrectomy

laparoscopic approach = gold standard

23
Q

follow up for RCC after treatment?

A

FBC/renal and liver functions
imaging CT/US + CXR
duration = 5-10 years follow up

24
Q

who is testicular cancer most common in?

A 
most common solid cancer in men 20-45
white Caucasians in Europe and USA
cryptorchidism (undescended testicle)
- subsequent orchidoplexy can reduce risk if performed before 13 yrs old
HIV
family history
previous cancer in other testicle
25
Q

3 types of testicular cancer?

A

seminomatous (most common)
non-seminomatous
mixed germ cell tumour

26
Q

types of non-semiomatous?

A

teratoma
yolk sac
choriocarcinoma

27
Q

how does testicular cancer present?

A

scrotal lump
5% have acute pain due to bleeding
only 10% have systemic symptoms of advanced disease (weight loss, chest symptoms, neck lumphs, bone pain)

28
Q

examination?

A

asymmetrical or slight scrotal discolouraion
hard, non-tender irregular mass (mostly intratesticular)
assess involvement of epididymis, spermaic cord and scrotal skin
secondary hydrocele
abdominal mass = advanced disease

29
Q

investigation of testicular cancer?

A

imaging (US of testicle, CT chest for staing)
blood tests
- serum tumour markers (alpha feto protein, B - HCG, LDH)
- FBC
- liver function tests
- renal function tests

30
Q

how is testicular cancer managed?

A

radiacal inguinal orchidectomy (offer sperm preservation and prosthesis)
re-check tumour markers 1 week post-op if they were elevated pre-op
chase CT scan if metastatic disease is suspected
further follow up by oncologist (chemotherapy as adjuvant treatment)

31
Q

treatment if testicular cancer is metastatic?

A

chemotherapy first

32
Q

what is penile cancer?

A

basically a skin cancer

95% are squamous cell carcinoma

33
Q

types of penile cancer?

A 
95% are squamous cell
kaposis carcinoma
basal cell carcinoma
melanoma
sarcoma
34
Q

risk factors for penile cancer?

A 
5-6th decade
pre-malignancy conitions
phimosis (chronic inflammation)
asia, Africa, south America
HPV (type 16 and 18)
smoking
immunocompromised
35
Q

how does circumcision affect penile cancer risk?

A

lowers risk

36
Q

where does penile cancer uually occur?

A

most on the glans

37
Q

how does penile cancer present?

A

hard painless lump
15-50% delayed presentation for >1 year due to embarrassment, fear etc
can rarely get urinary retention or groin mass (due to inguinal lymphadenopathy)

38
Q

examination of penile cancer?

A

abdomen
inguinal region
external genitalia
(looking for lymph nodes)

39
Q

investigation of penile cancer?

A

CT scan abdomen, pelvis, chest in advanced disease

40
Q

how is prepucial lesion penile cancer managed?

A

circumcision

41
Q

how are glans lesions managed?

A 
superficial = glans resurfacing
deep = glansectomy
42
Q

how is more advanced penile cancer managed?

A

total penile amputation with formation of penile urethrostomy

43
Q

how is lymph node involvement in penile cancer managed?

A

inguinal lymphadenectomy

Renal (34 decks)

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