Flashcards in Genitourinary Deck (378)
How common is testicular cancer?
It is the most common malignancy in men aged 15-44
What is the cause of testicular cancer?
undescended testis (even after ochidopexy), infant hernia, infertility
What are the 4 types of testicular cancer?
non seminomatous germ cell tumour
mixed germ cell tumour
What is the most common testicular cancer?
What is the more common testicular cancer in 20-30 year olds?
non seimnomatous germ cell tumour
What are the symptoms of testicular cancer?
testis lump, haemospermia, secondary hydrocele, pain, dyspnoea, abdominal mass, effects of secreted hormones (testosterone), metastases
What are the 4 stages of testicular cancer?
1 - no metastases
2 - infradiaphramatic node involvement spread via para aortic nodes
3 - supradiaphramatic node involvement
4 - lung involvement
What investigations should be done in testicular cancer?
CXR, CT and US of testis, excision biopsy, a-FP, B-hCG mildly raised, increased serum LDH
What is the treatment of testicular cancer?
radical orchiectomy, surgery, radiotherapy, chemotherapy, self examination education
stage 3 - cycles of bleomycin and etoposide and cisplatin
What is involved in a radical orchiectomy?
Inguinal incision to occlude spermatic cord before mobilisation to reduce risk of intra operative spread
What is the prognosis of testicular cancer?
>90% 5 yr survival
What is the most common age to get prostate cancer?
What are risk factors for prostate cancer?
age, family history, african
What are the symptoms of prostate cancer?
weight loss, malaise, fatigue, bone pain and fracture, normocytic anaemia, hypercalcaemia, purpura, immune suppression, anorexia, thirst, confusion, collapse, hard irregular gland
What will a per rectum examination show in prostate cancer?
enlarged prostate gland, uninodular or multinodularr, midline sulcus is not palpable
What is protein specific antigen?
It is expressed from normal and neoplastic prostate tissue and secreted into the blood stream?
What is an abnormal PSA level and what level is seen in 50% of men with prostate cancer?
What percentage of people with elevated PSA levels do not prostate cancer?
What investigations should be done for prostate cancer?
FBC, U and E, creatining, LFTs, transrectal US, transrectal prostate biopsy, endorectal coil MRI for staging, TNM staging, urine dipstick, microscopy, PCA3, gene fusion products
What is used for prostate cancer grading?
The Gleason grading score form the biopsy, add the two most common together, and the higher the more aggressive
What does the prostate cancer screening involve?
annual measurement of serum PSA and digital rectal examination
Where is the most common site for metastases from the prostate?
The bone, leading to bone pain and fracture
What are some disadvantages of the prostate cancer screening?
cost, variable intervals of testing, increased anxiety, overdiagnosis
What is the treatment for prostate cancer?
macmillan nurses and psychological support
radiotherapy with external beam and brachytherapy
high intensity US
Goserelin - a LHRH agonist
Antiandrogens e.g. cyproterone
Transuretheral resection of prostate (TURP)
Laparoscopic radical prostatectomy
How does androgen deprivation therapy work in the treatment of prostate cancer?
Uses GnRH agonists e.g. goserline, leuprorelin, orchidectomy to lower circulating androgens
What does androgen deprivation therapy for prostate cancer have to be used with?
Needs an antiandrogen e.g. flutamide in the 1st phase due to the initially increase LH and testosterone which could cause a flare in metastases.
The antiandrogen inhibits CYp17 for androgen production to prevent flare
What should be used for prostate cancer treatment if resistant?
2nd line hormone therapy e.g. abiratone which inhibits adrenal androgen synthesis
What is the treatment of prostate cancer if no metastases?
Androgen deprivation therapy and radiotherapy
What parts of the body are lined with transitional cell epithelium?
calyces, renal pelvis, bladder, urethra