8.8 Renal Tumours & Prostate Cancer Flashcards
(12 cards)
3 most common benign renal tumours
1. Oncocytoma
- benign variant of renal cell ca
- indistinguishable on imaging
Adenoma
- precursor to RCC
Angiomyolipoma (AML)
- hamartoma containing fat, muscle and blood vessels
- associated with tuberous sclerosis
- can rupture if enlarges (preg)
Etiology of RCC (renal cell ca)
- hypertension
- obesity
- acquired renal cystic disease
- von-hippel-lindua disease - familial syn (autosomal dominant)
- renal adenoma
- smoking
RCC pathology
- arises form proximal tubular epithelium
Primary types
- clear cell
- papillary (type 1&2)
- chromophobe
- collecting duct
- sarcomatoid
RCC spread of cancer
Local spread
- anatomical planes
- perinephric fat & fascia
- adrenal gland
- posterior abdominal wall
- can form tumour thrombus along veins: renal vein -> IVC -> Right atrium
- surrounding organs (rare)
Lymphatic spread
- hilar
- para-aortic
- mediastinal
- supraclaviclar
Haematgenous
- lungs
- liver
- bone
- brain
Unique pathological features of RCC
- thrombus forming tumour
- can get very big before metastasising
- produce toxins & hormones (para-neoplastic syn)
- can metastasise to unorthodox sites (vagina, bladder, parotid glands)
What is the mortality : incidence ratio of prostate cancer in Africa
71%
7 out of 10 men diagnosed will die
- we diagnose it too late
Risk factors for prostate cancer
Age
- ⬆️ age (>70) : ⬆️ incidence
Black ethnicity
- earlier onset
- increase incidence
- more aggressive
Family history
- first degree relative (male/female)
- prostate, breast, cervix (BRCA 2 gene)
Natural progression of prostate cancer
1. Early-stage
- 5 year survival rate for Stage 1&@ men is 90%
- 10 year survival rate >65%
2. Advanced tumours
- have already spread (lymph / blood)
- controlled by ADT (androgen deprivation therapy) {testosterone stim tumour growth and ADT stops testosterone}
- limit or relive sec sym
- prolong rime to clinical prgress
3. Resistant tumours
- hormonal - and castration resistant
Prostate cancer pathology
- adenoca
- Starts: peripheral zone (malignant)
- slow growing
- Benign prostate cancer more from transitional zone
Grading for prostate cancer
Gleason criteria
looks at gland (architecture and differentiation)
- Small, uniform glands
- More stroma between glands
- Distinctly infiltrative margins
- Irregular masses of neoplastic glands
- Only occasional gland formation
- two scores given (sum of theses scores)
predominant primary pattern + second most predominant pattern (secondary)
The lower the better
Spreading pattern of prostate cancer
- local (urethra, bladder neck, trigone, sv, urethral orifice)
- lymphatic (iliacs -> para-aortic)
- hematogenous (bone & lungs)
PSA (Prostate specific antigen)
- in lumens of prostatic glands
- disruption of barriers between gland lumens and capillaries cause serum PSA levels to rise
- half life in circulation is ± 3.2 days
- PSA in serum = prostatic disease (not cancer specifically)
Factors influencing PSA
- medication
- catheterization (⬇️)
- ejaculation
- acute prostatitis
- subclinical or chronic prostatitis
- urinary retention
- needle biopsies of prostate
