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Flashcards in deck_1664614 Deck (44):

Name three main risk factors for prostate cancer

• Age • Family history • Race


How is age a risk factor for prostate cancer?

• There is a correlation with increasing age • Uncommon in men younger than 50


How is family history a risk factor for prostate cancer?

• 4x increased risk • If one 1st degree relative is diagnosed with prostate cancer before age 60 • After 60 diagnosis probably age related


How is prostate cancer related to race?

• Incidence in asian


Give the usual presentation of prostate cancer

• Vast majory asymptomatic • Urinary symptoms ○ Benign enlargement of prostate ○ Bladder over activity ○ +/- CaP • Bone pain ○ Advanced metastatic


Give an unusual symptom of prostate cancer



Outline how prostate cancer is diagnosed

• A digital rectal examination • A serum PSA ○ Used to assess wether or not a biopsy in necessary • If it is, carried out via a TransRectal UltraSound guided biopsy of prostate • Lower urinary tract symptoms are treated with a TransUrethral Resection of Prostate


Give 5 factors influencing treatment decisions in prostate cancer

MADBP • Age • Digital Rectal Exam • PSA level • Biopsies • MRI scan and bone scan


What are the three different results you can get from a digital rectal exam?

• Localised (T1/2) • Locally advances (T3) • Advanced (T4)


What can biopsies tell us about the advancement of prostate cancer?

• Gleason grade


What is a Gleason grading?

• Pathologist adds together grading score of most common cell type and adds to highest graded prostate tissue


Give three treatments for established prostate cancer

• Surveillance ○ Watch cancer, tumor not severe enough to outweigh risks of treatment • Radical prostateectomy Radiotherapy - External beams or low dose brachytherapy


Give three treatments for developmental prostate cancers

• High intensity focused ultrasound • Primary cryotherapy - freeze the prostate • Brachytherapy - High dose (small rods implanted in prostate)


How can metastatic prostate cancer be treated?

• Hormones ○ Surgical castration, medical castration • PalliationSingle-dose radiotherapy, bisphosphonates, chemotherap


Give three ways to treat locally advanced prostate cancer

• Surveillance • Hormones • Hormones & radiotherapy


What is haematuria?

• Blood in urine • Classified as visible or non-visible


What does it mean if haematuria is visible?

• On investigation there is a 20% chance a malignancy is present


What does it mean if haematuria is non-visible?

• Can be symptomatic or asymptomatic Detected via microscopy or urine dipstick


Give three causes of haematuria

• Cancer • OtherNephrological


Give four types of cancer which can cause haematuria

• Renal cell carcinoma • Upper tract transition cell carcinoma • Bladder cancer • Advanced prostate cancer


Give five non-cancerous causes of haematuria

• Stones • Infection • Inflammation • Benign prostatic hyperplasiNephrological


What questions must be taken on investigating the history of someone with haematuria?

• Smoking • Occupation • Pain levels • Other UTI symptoms • Family history


What should be looked for on examination of someone with haematuria

• BP • Abdominal mass • Varicocele – collection of veins in the scrotum (‘bag of worms’) • Leg swelling • Assess prostate by DRE (male) – Size, texture


What investigations should be done for haematuria?

• Urine culture • Cytology • FBC • Ultrasound • Flexible cystoscopy


Outline the epidemiology of bladder cancer

• 7th most common cancer in the UK, but incidence decreasing] • Male to female ratio 2.5:1 and 90% are transitional cell carcinomas


Give three large risk factors for bladder cancer

• Smoking • Occupational exposure • Schistomiasis


How much does smoking increase risk of bladder cancer?

• 4x increased risk


Give three examples of occupational exposure increasing risk of bladder cancer

• Rubber or plastics manufacture (arylamines) • Handling of carbon, crude oil, combustion (polyaromatic hydrocarbons) • Painters, mechanics, printers, hairdressers


Outline the staging of bladder cancer

• 75% of cancers are superficial • 5% are in situ • 20% are muscle invasive


Give three types of bladder cancer which all have different treatments

• High risk non-muscle invasive TCC (transitional cell carcinoma, you simpleton) • Low risk non-muscle invasive TCCMuscle invasive TCC


Give two treatments for high risk non-muscle invasive TCC

• Check cystoscopies • Intravesical chemotherapy/immunotherapy


Give a treatment for low risk non-muscle invasive TCC

• Check cystoscopies


Give two courses of treatment for muscle invasive TCC

• Potentially curative ○ Radical cystectomy or radiotherapy (+/- chemotherapy) ○ Not curative • Palliative chemotherapy/radiotherapy


What is a radical cystectomy?

• Removal of the urinary bladder


What can be done after a radical cystectomy to simulate a bladder?

• A piece of ileum may be used to make a conduit from the ureters to the abdomen, where urine can be collected in a bag • May also attempt to reconstruct the bladders from a piece of small intestine


Outline the epidemiology renal cell carcinoma

• 8th most common cancer in the UK, making up 95% of all upper urinary tract tumours • Male to female ratio of 3:2 and 30% have metastases on presentation


Give three risk factors for RCC

• Smoking • Obesity • Dialysis


Where does RCC mestatasise to?

• Lymph nodes • Up the renal vein • Vena cava into right atrium • Into subcapsular fat (perinephric spread)


What is the established treatment for RCC?

• Surveillance • Radical nephrectomy ○ Removal of kidney, adrenal, surrounding fate and upper ureter • Partial nephrectomy


Give a developmental treatment for RCC

• Ablation ○ Removal of tumour via erosive process


Give two palliative treatments for RCC

• Molecular therapies targeting angiogenesis • Immunotherapy


What is the epidemiology of Upper Tract Transitional Cell Carcinoma (TCC)

• Only 5% of malignancies of URT (Rest are RCC) • 5% due to spread of cancer from bladder • 40% of cancers of the URT spread to bladder


Give four investigations for Upper Tract TCC

• Ultrasound • CT urogram • Retrograde pyelogram (inject contrast into ureter) • Ureteroscopy ○ Biopsy ○ Washings for cytology


What is the treatment for upper tract TCC?

• Nephro-ureterectomyRemoval of the kidney, fat, ureter and cuff of bladder