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Renal > GU Tract Cancers > Flashcards

GU Tract Cancers Flashcards

1
Q

Where do renal cell carcinomas arise from?

A

Proximal renal tubular epithelium

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2
Q

Epidemiological factors of renal cell carcinoma

A

90% of all renal cancers
Mean age 55
F:M = 2:1
15% of haemodialysis patients develop RCC

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3
Q

Features of renal cell carcinoma

A 
50% found incidentally 
Haematuria
Loin pain 
Abdominal mass
Anorexia, malaise and weight loss 
PUO - often in isolation
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4
Q

What is a rare feature of renal cell carcinoma?

A

Invasion of left renal vein compresses the left testicular vein causing a varicocele

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5
Q

Spread of renal cell carcioma

A

Direct - renal vein
Via lymph
Or haemotogenous (bone, liver, lung)

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6
Q

% who have mets at presentation with renal cell carcinoma

A

25%

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7
Q

Findings in blood in RCC

A

Polycythaemia due to increased erythropoietin production
ALP - mets
HTN from increased renin production

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8
Q

Imaging in RCC

A

US
CT/MRI
CXR - “cannon ball” mets in lung from RCC

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9
Q

Treatment of RCC

A

Radical nephrectomy
RCC usually radiotherapy and chemotherapy resistant
Can do nephron sparing surgery if small T1 tumour

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10
Q

Treatment of unresectable or metastatic RCC

A

Some have good response to biological therapies - angiogenesis target agents
eg. Sunitinib, Bevacizumab, Sorafenib

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11
Q

1st line treatment for patients with multiple poor risk factors

A

Temsirolimus improves survival better than interferon (previous treatment)

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12
Q

What is Wilms tumour?

A

Nephroblastoma
Childhood tumour of primitive renal tubules and mesenchymal cells
Chief abdominal malignancy in childhood
Presents with abdominal pain and haematuria

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13
Q

Incidence of prostate cancer

A

Increases with age and 80% of men over 80 years

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14
Q

Associations of prostate cancer

A

Family history 2-3x increased risk

High testosterone

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15
Q

Spread of prostate cancer

A

Local - seminal vesicles, bladder, rectum
Lymph
Haematogenously - sclerotic bone lesions

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16
Q

Presentation of prostate cancer

A

Can be asymptomatic
Or nocturia, hesistancy, poor stream, terminal dribbling or obstruction
Weight loss and bone pain - suggests bony mets

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17
Q

DRE in prostate cancer

A

May show hard, irregular prostate

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18
Q

DX of prostate cancer

A

PSA - normal in 30% of small cancers
Transrectal USS & biopsy
Xrays
Bone scan

19
Q

Staging of prostate cancer

A

MRI - contrast-enhancing detecting nodes rises up to 90%

20
Q

Treatment of disease confined to prostate

A

Radical prostectomy if

21
Q

Treatment of metastatic prostate cancer

A

Hormonal drugs - may give 1-2 years benefit
LHRH agonists eg. goserelin (risks tumour flare because first stimulates then inhibits pituitary gonadotrophin- therefore start anti-androgen eg. cyproterone acetate)

LHRH antagonist - degarelix used in advanced disease

22
Q

Prognosis of prostate cancer

A

10% die in 6months 10% live for >10 years

23
Q

Screening of prostate cancer with PSA

A

Not very accurate and 1/3 with high PSA will not have prostate cancer
Cancer found won’t necessarily impinge on health

24
Q

Epidemiology of penile cancer

A

Rare in UK
More common in far east and africa
Very rare in circumcised

25
Q

What is penile cancer related to?

A

Chronic irritation, viruses and smegma

26
Q

Presentation of penile cancer

A

Chronic fungating ulcer
Bloody/purulent discharge
50% spread to lymph at presentation

27
Q

Treatment of penile cancer

A

Radiotherapy and irridium wires if early

Amputation and lymph node dissection if late

28
Q

What sort of cancer are bladder cancers normally?

A

> 90% are transitional cell carcinoma

these can also occur in renal pelvis, and ureter

29
Q

Rarely causes of bladder cancer

A

Adenocarcinoma

Squamous cell carcinoma (follows schistosomiasis)

30
Q

Histological grading of bladder cancer

A

Grade 1 = differentiated
Grade 2 - intermediate
Grade 3 = poorly differentiated

80% confined to bladder mucosa
only 20% penetrate into muscle - increased mortality to 50% at 5 years

31
Q

Presentation of bladder cancer

A

Painless haematuria
Recurrent UTIs
Voiding irritability

32
Q

Associations of bladder cancer

A 
Smoking 
Aromatic amines
Chronic cystitis 
Schistosomiasis 
Pelvic irradiation
33
Q

DX of bladder cancer

A

Cystoscopy with biopsy

MRI or lymphangiography may show involved pelvic nodes

34
Q

Investigation to help staging

A

EUA

35
Q

Staging of bladder cancer

A

Tis - carcinoma in situ - not felt at EUA
Ta - tumour confined to epithelium - not felt at EUA
T1 - tumour in lamina propria - not felt at EUA
T2 - superficial muscle involved - rubbery thickening et EUA
T3 - deep muscle involved - EUA: mobile mass
T4 - invasion beyond bladder - EUA: fixed mass

36
Q

Treating Tis-T1 bladder cancer

A

80% of all patients
Diathermy via transurethral cystoscopy
or
Transurethral resection of the bladder tumour

37
Q

If multiple Tis-T1 bladder cancers

A

Consider intravesical chemotherapeutic agents

Mitomycin c, doxorubicin and cisplatin - maintenance to prevent recurrence (MCDC)

38
Q

Prognosis of Tis-T1 bladder cancers

A

95% 5 year survival

39
Q

Treatment of T2-T3 bladder cancers

A

Radical cystectomy = gold standard
Radiotherapy - worse5 year survival but saves bladder
Post-op chemo: M-VAC - methrotrexate, vinblastine, adriamycin and cisplatin - toxic but effective

IF neck not involved - can do reconstruction using ileum but otherwise urostoma

40
Q

Treatment of T4 bladder cancers

A

Usually palliative chemo/radiotherapy

41
Q

Follow up in high-risk bladder tumours

A

Every 3 months for 2years and then every 6 months

42
Q

Follow up in low-risk bladder tumours

A

First follow up cystoscopy after 9 months and then yearly

43
Q

Spread of bladder cancers

A

Local to pelvic structures
Lymphatic to iliac and para-aortic nodes
Haematogenous to liver and lungs

44
Q

Infective agent in HUS

A

E coli

Renal (9 decks)

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