CCs - in brief

Question 1

How do bladder carcinomas present?

Answer 1

Painless haematuria
Recurrent UTIs
Voiding irritability (urgency, pain, frequency)

Question 2

Where do bladder carcinomas spread?

Answer 2

20% undergo local invasion and penetrate muscle
Further local invasion –> pelvic structures
Lymphatic spread –> iliac and para-aortic nodes
Haematogenous spread –> liver and lungs
>90% are transitional cell carcinomas

Question 3

What risk factors are there for bladder cancer?

Answer 3

Smoking
Aromatic amines (rubber industry)
Chronic cystitis
Schistosomiasis
Pelvic irradiation

Question 4

What types of kidney cancer are there?

Answer 4

Renal cell carcinoma (90%)

Nephroblastoma / Wilm’s tumour (children)

Question 5

What is the epidemiology of renal cell carcinoma?

Answer 5

Mean age = 55 yrs
2M:1F
15% of all haemodialysis patients develop RCC
50% found incidentally
20-95% 10YSR

Question 6

How does renal cell carcinoma present?

Answer 6

Haematuria
Loin pain
Abdominal mass
Anorexia
Malaise
Weight loss
PUO
High BP (from renin secretion)
25% have metastases at presentation (bone, liver, lung)

Question 7

How is renal cell carcinoma managed?

Answer 7

Generally chemo- and radio-resistant
Radical nephrectomy
T-cell activation therapy

Question 8

Where are urinary stones classically deposited?

Answer 8

1. Pelviureteric junction
2. Pelvic brim
3. Vesicoureteric junction

Question 9

How do urinary stones present?

Answer 9

Can be asymptomatic
Pain - excruciating spasms of renal colic, loin to groin, often cannot lie still
Coexisting infection
Haematuria
Proteinuria
Sterile pyuria(high WCC, no bacteria)
Anuria

Question 10

What are the indications for urgent treatment?

Answer 10

Presence of infection and obstruction –> percutaneous nephrostomy / ureteric stent
Urosepsis
Intractable pain / vomiting
Risk of AKI