Malignancy

Question 1

what kind of cancer is RCC

Answer 1

adenocarcinoma (most commonly clear cell)

Question 2

RF for RCC

Answer 2

smoking, obesity, dialysis, Von Hippel–Lindau disease

Question 3

2WW for RCC

Answer 3

45+ with unexplained haematuria

Question 4

triad of symptoms for RCC

Answer 4

haematuria, palpable mass, flank pain

Question 5

which side varicocele is a sign of RCC

Answer 5

left (due to drainage, drains pampiniform plexus –> testicular vein –> left renal vein and then IVC. Not right side does not have a renal vein)

Question 6

gold standard investigation for visible haematuria

Answer 6

CT urogram!!!

Question 7

other investigations that may be done for a haematuria

Answer 7

bloods (Hb - due to paraneoplastic syndrome of increased EPO, Ca due to PTHrP), urinalysis, US, CT CAP for staging

Question 8

Mx of RCC

Answer 8

partial / total nephrectomy depending on size. immuno/radio but NOT CHEMO

-the biological therapy uses anti VEGF

Question 9

RF for testicular cancer

Answer 9

infertility, cryptorchidism, previous malignancy, klinefelters

Question 10

what are the divisions of testicular cancer

Answer 10

germ cell tumours (seminoma / non seminomas) and NGCT ( leydig and sertoli - but these are usually benign)

Question 11

features of a seminoma

Answer 11

average age for diagnosis is 40, good prognosis, rarely metastasise, no tumour markers

Question 12

what are the 3 non seminomatous germ cell tumour

Answer 12

1) yolk sac (AFP) 2) teratoma 3) choriocarcinoma (HCG)

Question 13

investigation for a testicular tumour

Answer 13

tumour markers, US, CT - never biopsy

Question 14

MX of a testicular tumour

Answer 14

orchidectomy +/- chemo

Question 15

what race are more at risk of testicular cancer

Answer 15

Caucasian

Question 16

RF for prostate cancer

Answer 16

FHX (BRCA2) obesity and age

Question 17

prostate feel on DRE with cancer

Answer 17

loss of median sulcus, irregular and craggy

Question 18

Ix for prostate cancer

Answer 18

DRE, PSA, multi parametricMRI, transperineal US guided biopsy (TRUS outdated)

Question 19

what is the gleason score

Answer 19

grade of the prostate cancer where 1 is least dysplasia and 5 is most. the two scores added from two most prominent cell types

Question 20

complications of prostatectomy

Answer 20

ED and stress incontinence

Question 21

mainstay of Tx for metastatic prostate cancer

Answer 21

hormonal (GnRH agonist - overstimulate receptors, they get down regulated and cause less testosterone after initial flare). Tumour flare needs to be covered with anti androgen to begin with.

Chemo can be used

Question 22

what is generally used for locally advanced prostate cancer

Answer 22

surgery - prostatectomy or radiotherapy

Question 23

what is used for localised early prostate cancer

Answer 23

watch and wait / active surveillance or may use prostatectomy / radiotherapy

Question 24

main side effect of using radiotherapy to treat prostate cancer

Answer 24

proctitis

Question 25

2WW criteria for haematuria

Answer 25

45+ and unexplained haematuria or 60+ with unexplained non visible haematuria AND dysuria/raised WCC

Question 26

Rf for TCC

Answer 26

SMOKING, exposure to aromatic dyes and age

Question 27

symptoms of TCC

Answer 27

haematuria and LUTS

Question 28

Mx of a Cis TCC

Answer 28

TURBT +/- BCG vaccine into the bladder (This is done for high risk cancers)

Question 29

RF for squamous cell carcinoma of bladder

Answer 29

long term catheter and schistosomiasis

Question 29

at what point is a TCC muscle invasive and needs radical cystectomy

Answer 29

T2

Question 30

what are the methods of urodiversion after a radical cystectomy

Answer 30

1) ileal conduit (part of ileum taken and bought to skin surface and the ureters plumbed in) 2) bladder reconstruction (neobladder)

Question 31

how is wilms tumour treated

Answer 31

nephrectomy

Question 31

What is wilms tumour

Answer 31

a nephroblastoma - in children. Present with mass, loin pain and haematuria.

Question 32

what is TURP syndrome

Answer 32

when there is absorption of the hypoosmolar irrigation fluid. Causes fluid overload and a low sodium. May present with confusion.

Question 33

RF for penile cancer (squamous cell cancer)

Answer 33

HPV, poor hygiene, smoking

Question 34

presentation of penile cancer

Answer 34

palpable, ulcerated lesion / skin changes +/- pelvic lymphadenopathy

Question 35

Mx of penile cancer

Answer 35

penectomy +/- chemo/radio

Question 36

what is it called where RCC cause problems with liver

Answer 36

stauffer syndrome (exact mechanism for this is not understood)

Question 37

staging of RCC

Answer 37

T1 - <7cm T2 - >7cm T3 - spread but not beyond gerotas fascia T4 - spread beyond gerotas fascia

Question 38

what is gerotas facia

Answer 38

separates kidneys AND adrenal glands form other organs

Question 39

what is stauffer syndrome

Answer 39

in RCC it is a paraneoplastic syndrome which causes hepatic dysfunction without the presence of live mets. It then resolves after nephrectomy.

Question 40

RCC summarise

Question 41

Tx for bladder cancer Cis

Answer 41

TURBT + intravesicular chemo

Question 42

Tx for muscle invasive bladder cancer

Answer 42

radical cystectomy

Question 43

staging of bladder cancer

Answer 43

MRI pelvis and then CT CAP to look for more distant metastasis