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Block 34 metabolic -Ellen > Haematuria PT1 > Flashcards

Haematuria PT1 Flashcards

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1
Q

mortality of kidney cancer

A

40%

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2
Q

most common type of renal tumour

A

renal cell carcinoma

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3
Q

renal cell carcinoma affects

A

the proximal convoluted tubule

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4
Q

second most common form of kidney cancer

A

transitional cell carcinoma

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5
Q

describe cells of renal cell carcinoma

A
  • clear cytoplasmic polygonal cells

- with carbohydrate and lipid deposits forming yellow cells

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6
Q

inherited mutation that can cause RCC

A

von-Hippel lindau gene on 3P chromosome

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7
Q

what does mutation of the von-hippel lindau gene cause

A

increases secretion of IGF-1 growth factor upregulating expression of hypoxic-inducible factors (HIF)

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8
Q

3 genes HIF promotes the transcription of

A
  • vascular endothelial growth factor
  • platelet-derived growth factor
  • epidermal growth factor receptor
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9
Q

2 ways RCC can develop

A

sporadic

inherited

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10
Q

sporadic RCC tumours more common in

A

upper poles of kidneys in older men who have smoked

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11
Q

when does inherited von-Hippel Lindau RCC disease occur

A

younger men and women

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12
Q

inheritance pattern of Hippel Lindau RCC

A

autosomal - child with 1 parent has 50% chance of inheriting disorder

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13
Q

other organs impacted by Von-Hippel Lindau disease

A
  • retinal angiomas
  • pheochromocytomas
  • pancreatic neuroendocrine tumours
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14
Q

signs and symptoms of RCC (6)

A
  • asymptomatic
  • classic triad- haematuria, flank pain and palpable abdo mass (<10%)
  • fever & weight loss
  • anaemia
  • bone pain
  • paraneoplastic syndromes
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15
Q

paraneoplastic syndrome=

A

when tumours act as ectopic endocrine organs resulting in over-secretion of hormones

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16
Q

paraneoplastic syndromes of RCC (3)

A
  • EPO secretion
  • renin release
  • PTH-RP
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17
Q

excess PTH-RP leads to

A

hypercalcaemia

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18
Q

excess EPO leads to

A

polycytheamia

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19
Q

excess renin leads to

A

hypertension

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20
Q

in a late stage RCC what can happen to the left renal vein

A

can become compressed interrupting the venous draining of the left testies -left scrotal varicocele

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21
Q

in late stage RCC what can the tumour invade

A

IVC resulting in lower limb oedema

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22
Q

risk factors of RCC (9)

A
  • smoking
  • obesity
  • hypertension
  • age
  • male
  • PKD
  • dialysis
  • testicular/ gynaecological radiotherapy
  • family history
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23
Q

treatment of early stage RCC

A
  • partial or total local resection nephroctomy
  • radiotherapy
  • cryotherapy
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24
Q

treatment of stage 3 RCC

A
  • radical nephrectomy

- adjuvant therapy with targeted molecular therapy - Sunitinib first line

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25
sunitinib=
tyrosine kinase inhibitor
26
adjuvant therapy of RCC stage 3 (4)
- IFN-alpha monoclonal antibody - sunitinib - Bevacizumab - Temsirolimus
27
Treatment of RCC stage 4 (5)
- targeted molecular -therapy - surgery - clinical trials - chemotherapy - palliative care
28
most common cause of malignant renal carcinomas in children under 15 =
Wilms disease
29
what is Wilms disease
a triphasic nephroblastoma
30
what does a triphasic nephroblastoma consist of (3)
- metanphric blastemal cells - mesenchymal stromal cells - Epithelial cells
31
a blastema=
- a mass of cells capable of growth and regeneration into organs or body parts - undifferentiated pluripotent cells
32
how does a nephroblastoma in Wilms disease occur
unregulated proliferation of metanephric blastemal cells
33
where is a blastema seen in development
early stages of genitourinary developement
34
mutation in Wilms disease
11p14 locus and WT1 tumour suppressor genen
35
when does the DNA mutation happen in Wilms disease
pre-zygotic DNA
36
pattern of the tumours in Wilms disease (4)
- unilateral - capsulated - vascularised - do not cross midline
37
precursor lesions in Wilms disease
nephrogenic rests (microscopic foci of primitive blastemal)
38
a kidney affected by Wilm's tumour will histologically show
abortive/ partly developed glomerular and tubular structures
39
associations with Wilms disease
- WAGR syndrome | - Beckwith-wiedemann syndrome
40
signs of symptoms of Wilms disease (5)
- palpable flank mass - abdominal distension - pallor (anaemia) - haematuria - hypertension
41
what defines the level of the tumour in the TNM staging of renal cancer
gerota's fascia (connective tissue encapsulating the kidney and adrenal gland)
42
which stage does the tumour invade the renal fascia
T4
43
5 sub-groups of RCC
- clear cell - papillary - chromophobic - collecting duct - unclassified
44
percentage of renal tumours that are RCC
80%
45
4th commonest cancer in men=
bladder cancer
46
overal mortality of bladder cancer
50%
47
signs and symptoms of bladder cancer (5)
- painless gross haematuria - irritative bladder symptoms - recurrent UTIs - pelvic or bone pain - palpable mass
48
haematuria present at start of the urinary stream indicates
urethral damage
49
risk factors for bladder cancer
-smoking -occupation- aromatic dyes -age >55 years -pelvic radiation -male family history -chronic UTIs -schistomiasis
50
chronic UTIs can lead to which type of bladder cancer
squamous cell carcinoma
51
bladder cancers as a consequence of schistomiasis
simple squamous carcinoma
52
spread of schistomiasis
contaminated water with parasites in freshwater snails
53
95% of bladder cancers are
transitional cell carcinomas
54
3 types of bladder cancer (most-least common)
- transitional cell - squamous - adenocarcinomas
55
why is bladder cancer more common than ureter and urethra
bladder is exposed to carcinogens longer with constant changing shape of transitional cells during urinary retention and micturition
56
at presentation what are most TCC in the bladder
multifocal (more than 1)
57
possible pattern of growth of TCC
papillary sessile carcinoma in situ
58
TCC p53 dependant - sessile and nodular carcinomas are (4)
- typically flat - rapidly proliferative - high grade - highly muscle invasive
59
p53 independent TCC tend to be
non-invasive bladder cancers -papillary tumours
60
squamous cell carcinoma of the bladder related to
schistosoma parasitic flatworm
61
2 features of squamous cell carcinoma of the bladder
- more invasive | - less metastatic than TCC
62
where does adenocarcinoma develop in the bladder
glandular tissue
63
cancer of the bladder muscle=
sarcomas
64
typically metastatic spread of bladder cancer is where
local
65
important investigations for bladder cancer
cystoscopy
66
treatment of non-muscle invasive bladder cancer
TURBT- transurethral resection of bladder tumour
67
how often do low grade bladder tumours undergo cystoscopic surveillance
5-10 years
68
moderately high grade non-muscle invasive bladder tumour treatment (3)
- intravesical chemo- mitomycin C cisplatin based - BCG immunotherapy - cystoscopic surveillance
69
locally invasive bladder tumour treatment
- radical or partical cystectomy with regional lymph node dissection - neoadjuvant cisplatin chemo
70
metastatic disease of bladder tumour treatment
palliative chemo | palliative radiotherapy for local symptoms
71
7 stages of bladder cancer (best to worse)
``` Tis Ta T1 T2 T3a T3b T4 ```
72
grade 1 bladder tumours =
well differentiated low grade
73
grade 3 bladder tumours=
poorly differentiated with loss of original cytological appearance and high grade growth

Block 34 metabolic -Ellen (8 decks)

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