Urological cancers Flashcards
What is your differential diagnosis for haematuria?
- UTI
- urolithiasis
- trauma
- urethritis
- BPH or prostate cancer
- renal carcinoma
- bladder carcinoma
- glomerulonephropathy
- renal cysts, polycystic renal disease
- sickle cell disease, coagulation disorders, anti-coagulation drugs
- sulphonamides, cyclophosphamide, NSAIDs
What are the main types of renal cancer? Which is most common in adults? In children?
- Renal cell carcinoma (80%): clear cell RCC most common, arise from proximal renal tubular epithelium
- Transitional cell carcinoma: arise from transitional cells in renal pelvis
- Wilm’s tumour: most common type in children
- Leiomyosarcomas, etc.
What is the most common site of renal cancer metastasis?
Lung: cannon ball secondaries
Suggest risk factors for the development of renal cancer.
- smoking
- obesity
- male
- HTN
- occupational exposure e.g. trichloroethylene
- long-term renal dialysis
- hereditary syndrome e.g. Von-Hippel Lindau
Describe the classical triad for renal cancer presentation.
- loin mass
- loin pain
- haematuria
Why might a person with a renal cancer present with polycythaemia?
Malignant EPO production (paraneoplastic syndrome)
A 52 yo male is referred to the 2ww haematuria clinic due to unexplained visible haematuria + loin mass. UTI has been excluded. Which Ix should be undertaken?
Bloods
- FBC: ?anaemia, ?polytcyhaemia (malignant EPO production)
- U&Es + creatinine
- calcium: ?hypercalcaemia
- LFTs: ?liver mets
- LDH: for prognosis
Imaging
- abdo USS: may be used initially
- abdo. cCT: more sensitive + staging, OR abdo. MRI: if contrast contra-indicated
- CXR, bone scan, brain CT: if Sx suggesting mets
Histology
- renal biopsy
What are the treatment options for RCCs?
If localised: partial (if <7cm) or total nephrectomy +/- RT +/- chemo
If advanced/metastatic: tumour nephrectomy + interferon a or IL-2
What is the most common type of bladder cancer? What are the risk factors for this?
Transitional cell carcinoma (90%)
- older male
- smoking (aromatic amines, polycyclin aromatic hydrocarbons)
- occupational exposure (paint, dye and metal industries)
- pelvic radiation
- cyclophosphamide
What are the risk factors for development of bladder squamous cell carcinomas?
- schistosomiasis
- chronic inflammation from stones/indwelling catheters
A 74 yo male smoker is referred to the 2ww haematuria clinic due to 2/52 history of visible haematuria + urinary frequency. UTI has been excluded.
Which initial Ix should be performed?
Bloods
- FBC: ?anaemia
- U+Es and creatinine: assess renal function
- LFTs + calcium: ?bone mets
- urine MC+S: cytology +ve in CIS and high-grade tumours
Histology
- cystoscopy + biopsy: for Dx + histology
Which Ix should be performed for staging bladder cancer?
- abdo/pelvis CT or MRI
- bone scan: if raised ALP or bone pain
- CXR: if ?lung mets
Which Tx should be offered for non-muscle invasive bladder cancer (according to risk level)?
- low risk (Ta): TURBT + single dose intravesicle mitomycin c
- intermediate risk: TURBT + 6 doses intravesicle mitomycin c
- high risk (CIS, high grade Ta, T1):
TURBT + intravesicle BCG
consider cystectomy if multiple risk factors
Which Tx options are there for people with locally invasive or metastatic bladder cancer?
organ-confined or non-organ confined (T3a/b):
- neoadjuvant chemo +
- cystectomy +/-
- prostatectomy/hysterectomy
- +/- LN dissection
non-organ confined (T4a/b) or metastatic disease: systemic chemo +/- RT
