Malignancies Flashcards
(44 cards)
Risk factors of prostate cancer?
Age (uncommon in under 50s)
Family history - increased risk if first degree relative diagnosed under 60
Ethnicity: Asian < Caucasian < Afro-Caribbean
How common is prostate cancer?
Most common cancer in men in the UK
Second most common cause of death from cancer in men
However most men likely to die with it than from it
Clinical presentation of prostate cancer?
Common
- asymptomatic
- urinary symptoms - benign enlargement of prostate, overactive bladder
- bone pain
Uncommon
-haematuria in advanced stages
Diagnostic pathway of prostate cancer?
Digital rectal exam
Serum prostate specific antigen (raised)
Transrectal ultrasound of prostate often with biopsy
Why do a transrectal ultrasound of the prostate with a biopsy?
Ultrasound
-more accurate estimation of size than DRE
Biopsy
-helps staging of tumour
How are lower urinary tract symptoms managed when there is an enlarged prostate?
Transurethral resection of prostate (TURP)
Go up urethra and cut through core of prostate to allow better ruined flow
Stages of prostate cancer?
Localised - T1/2
Locally advanced - T3
Advanced -T4
What factors influence treatment of prostate cancer?
Age DRE - stage PSA level Biopsy - Gleason grade MRI scan and bone scan - nodal and visceral mets?
Treatment of established prostate cancer?
Surveillance - if Gleason score is low. Treatment can do more damage
Radical prostatectomy
Radiotherapy
What are the two types of radiotherapy for prostate cancer?
External beam radiotherapy
Brachytherapy - radioactive seeds implanted in the prostate so radiation doesn’t escape prostate -> fewer systemic effects
Treatment of developmental prostatic cancer?
High intensity focused ultrasound Primary cryotherapy (freeze the prostate) Brachytherapy
Treatment of metastatic prostate cancer?
Hormones - medical castration
Surgical castration
Palliative - single dose of radiotherapy, bisphosphonates, chemotherapy
What is visible haematuria associated with?
Malignancy of urinary tract
20% chance
Differential diagnoses of haematuria?
Cancer
- renal cell carcinoma
- upper tract transition cell carcinoma
- bladder cancer
- advanced prostate cancer
Other
- stones
- infection
- inflammation
- benign prostatic hyperplasia
Nephrological
What history would you take for someone with haematuria?
Smoking Occupation Pain Other lower urinary tract symptoms Family history
What examinations would you do for someone with haematuria?
Blood pressure Abdominal mass Look for varicocele (collection of veins in scrotum) Leg swelling Prostate size and texture
What investigations would you do for someone with haematuria?
Urine culture and cytology
FBC
Ultrasound
Flexible cytoscopy
Epidemiology of bladder cancer?
4th most common cancer in men
5th most common in women
Incidence falling
Presentation more advanced in women
Most common type of bladder cancer?
Transitional cell carcinoma
Risk factors for bladder cancer?
Smoking
Occupational exposure (20yr latent period)
-rubber/plastics munufacture
-handling of carbon, crude oil, combustion, smelting
-painters, mechanics, printers, hairdressers
Schistosomiasis
Stages of bladder cancer?
Those that have not invaded basement membrane are benign so not included in TNM
Ta/T1 - superficial
Tis - in situ
T2-4 - muscle invasive
Treatment of transitional cell carcinoma?
If high risk and non-muscle invasive - intravesicular chemo/immunotherapy
If low risk non-muscle invasive - check gto?
If muscle invasive
- radical cystectomy or radiotherapy
- chemo - potentially curative
- palliative chemotherapy/radiotherapy
After a radical cystectomy, what is often used to replace the bladder?
Ileum can be used to make a conduit from ureters to abdomen where urine can be collected in a bag.
Can attempt to reconstruct the bladder from the small intestine.
What is the most common upper urinary tract malignancy?
Renal cell carcinoma
