Malignant tumours of GU tract Flashcards by James Reilly

Examples

Bladder carcinoma
Renal carcinoma (kidney)
Prostatic carcinoma
Testicular carcinoma

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Pathophysiology of bladder carcinoma

> 90% transitional cell carcinoma
Arises from the transitional cells of the mucosal urothelium.
Can invade the muscle to cause voiding symptoms.
Has a high propensity for metastasis.
(5% squamous cell carcinoma; v rare adenocarcinoma)

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Aetiology of bladder carcinoma

Genetic
Smoking
Aromatic amines and polycyclic aromatic hydrocarbons (working in a dye factory) are renally excreted
Increasing age
Risk factors: Paraplegia, Smoking, Occupation (carcinogens present), Drugs (aspirin, phenacetin), Bladder stones

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Clinical presentation of bladder carcinoma

Painless haematuria.
Advanced disease may have voiding symptoms.
Classic cancer symptoms.

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Epidemiology of bladder carcinoma

Smokers and dye factory workers
85% painless
24% malignant, 15 % present metastases
10yr survival in 50%

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Diagnostic tests of bladder carcinoma

Transurethral Resection of Bladder Tumour
Cystoscopy: Examine for signs of tumour
Biopsy: Determine cell type, confirm diagnosis
Urine cytology: Rule out infection

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Treatment of bladder carcinoma

Non-invasive: Transurethral resection
Invasive: Cystectomy (with orthotopic bladder substitute).
Chemotherapy (cisplatin)

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Complications of bladder carcinoma

Urinary retention
UTI
Recurrence
Metastasis

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Types of renal carcinoma

Renal cell carcinoma (arises from the renal tubule)

Transitional cell carcinoma (arising from the renal pelvis)

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Pathophysiology of renal cell carcinoma - what is secreted by the cell

Can secrete PTH (hypercalcaemia)
ACTH (Cushings like syndome)
EPO (polycythaemia)
renin (HTN)

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Common metastases from renal carcinoma

Lymphoma, lung, breast, skin

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Risk factors of renal carcinoma

Regular NSAID use
Obesity
Family Hx

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Clinical presentation of renal carcinoma

Haematuria
Abdominal mass
Lethargy
Anorexia
Weight loss
Abdo pain

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Diagnosis of Renal carcinoma

IVU: Dye stains kidney -> passes into ureters.
Blurs the outline.
Ultrasonography: Solid or cystic
CT: Preoperative staging

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Treatment of renal carcinoma

Surgical

Radio/chemo

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Pathophysiology of prostatic carcinoma

Adenocarcinoma.
Androgen driven.
Mostly affects the lateral lobes (in constrast to BPH).
Can spread through lymphatics, haematogenously, local invasion.

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Aetiology of prostatic carcinoma

Genetic (no specific gene).

Can develop from benign prostatic hyperplasia.

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Epidemiology of prostatic carcinoma

Most common cancer in men

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Clinical presentation of prostatic carcinoma

Serum PSA elevated.
Bladder outflow obstruction (I-PSS grading).
Occasionally; presents with metastases (usually to bone).

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Diagnosis of prostatic carcinoma

DRE: hard irregular gland
Ultrasound
Serum PSA: raised (markedly if metastasis)

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Treatment of prostatic carcinoma

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Microscopic: Watchful waiting
Confined to gland: Prostatectomy or radiotherapy
Metastatic: Androgen suppression (surgical/chemical castration)

Complications of prostatic carcinoma

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Metastasis

Death

Types of testicular carcinoma

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Seminoma

Teratomas

Clinical presentation of testicular carcinoma

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Classic cancer symptoms
Painless lump in the testicle
Possible mestastasis to the lung

Aetiology (RFs) of testicular cancer

Unknown | RF: Undescended testes, Family Hx

Pathophysiology of seminoma

96% arise from germ cells

Pathophysiology of teratomas

Composed of tissue not normally present at the site (teeth and stuff)

Epidemiology of testicular carcinoma

Most common cancer in young men

Diagnosis of seminoma

Ultrasound CXR/CT: Tumour staging; check metastases Serum conc Of beta-hCG: Raised

Treatment of seminoma

Surgery: Orchidectomy (offer sperm banking) Metastasis: Radiotherapy (Chemo if advanced)

Diagnosis of teratoma

No markers | CXR/CT: Tumour staging; check metastases

Treatment of teratoma

Surgery: Orchidectomy (offer sperm banking) Metastasis: Chemotherapy

Types of LUT stones

Bladder Kidney Ureteric

Types of trauma in LUT

Penetrating | Blunt

Types of infection in LUT

UTI Pyelonephritis TB

Epidemiology of renal cancer

3% of all cancers 4000 deaths/yr 66% diagnosed accidentally

Epidemiology of epididymitis (inflamed epididymus

Young males | Acute epididymitis mostly occurs in young males

epididymitis cause

Most common: E. coli and Chlamydia. Organisms may -> Epididymis by retrograde spread from prostatic urethra & seminal vesicles or less commonly, through blood stream.

Risks of epididymitis

UTI Urethral instrumentation STI

What is hydrocele

excessive fluid in tunica vaginalis (serous space surrounding testis)

Primary cause of hydrocele

Occur in absence of disease in testis. Tend to be large and tense. More common in young boys.

Secondary cause of hydrocele

Represent reaction to testicular pathology (testicular tumours / infections / torsion; H of Morgagni Torsion).

Risk factors of testicular tumours

Cryptorchidism Family Hx Previous testicular tumour Poorly understood

Epidemiology of testicular tumours

Most common tumours in males between 20 - 40, affecting 2 - 10 males / 100,000 / year. 92%: Malignant. Account for 1-2% of all male malignancies. Incidence is increasing.

Presentation of testicular tumours

80%: Painless lump in testis (hard/craggy, lies within testis, can be felt above, and does not transilluminate.) Usually painless, short history Often found incidentally. Other presenting symptoms include: HYDROCOELE: may contain bloodstained fluid PAIN: Unexplained in one testis - May be mistaken for orchitis METASTASES: Metastatic growths in Lung; Abdominal mass due to enlarged para-aortic lymph nodes; Cervical nodes.

Investigations/management of testicular tumours

``` USS same day Tumour markers: AFP (1/2 life 5 days) B-hcg (24-48hrs) LDH CXR if respiratory symptoms Staging CT ```

What is Orchidectomy

Testis and spermatic cord excised. Bx and frozen section for assess further treatment. If malignant testicular tumour.

Treatment of seminoma

Radiosensitive | RadTx for all stages except IV (ChemoTx)

Treatment of tetratoma

Cytotoxic chemotherpapy

What cells do most cancers of the testicle develop from

Germ cells

Types of germ cell tumours in men

Seminomas - slow growing, classic appearance Non-seminomas - made up of embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and/or teratoma. Rapid growth/met. Respond well chemo.

Malignant tumours of GU tract Flashcards

(51 cards)