Oncology

Question 1

Diagnostic investigation for prostate cancer

Answer 1

multiparametric MRI scan - can show Ca and staging

Question 2

Which part of the prostate is effected in BPH

Answer 2

transitional zone, hence why it usually presents with lower urinary tract symptoms

Question 3

Which part of the prostate is effected in prostate cancer

Answer 3

peripheral zone

Question 4

zones of the prostate

Answer 4

central, peripheral, transitional

Question 5

epidemiology of prostate ca

Answer 5

8% of all men. peak >70

western disease. afrocaribean 3x more likely

Question 6

Presentation of prostate ca

Answer 6

opportunistic screening
haematuria/haematospermia
?LUTS
Advanced - bony pain, neurology/cauda equina, systemic symptoms

Question 7

LUTS

Answer 7

storing - urgency, urgent incontinence, nocturia

voiding - dribbling, hesitancy, slow stream, incomplete emptying

Question 8

Red flag symptoms for prostate cancer

Answer 8

UTIs, bed wetting, haematuria, neurology. FH pf prostate ca and breast ca (related to BRCA1)

Question 9

PSA density

Answer 9

PSA/prostate volume.

over 1.5 then more likely to be prostate ca

Question 10

free PSA levels and Ca risk

Answer 10

higher risk of ca if free:total PSA ratio is low (ie there is higher levels of free psa)

Question 11

normal PSA level

Answer 11

40-50 = 2.5
50-60 = 3.5
60-70 = 4.5
70-80 = 6.5 
in general if over 3 not normal

Question 12

psa level and mets

Answer 12

less than 1% with a PSA under 20 have bony mets and less than 5% have nodal mets

Question 13

2WW to urology referal criteria for prostate ca

Answer 13

prostate feels malignant
PSA levels are above age-specific range
consider PSA in men with LUTS, erectile dysfunction or visible haematuria

Question 14

staging of prostate ca

Answer 14

T1 - inside prostate, cant be felt by dr during exam
T2 - inside. can be felt but not spread outside
T3 - Cancer spread outside into nearby tissues
T4 - cancner spread into nearby organs

Question 15

Grading of prostate Ca

Answer 15

transperineal vs transrectal 
Gleason grading 1-5 (1= small, unifrom glands. 2=more space (stroma) between glands. 3=distinctly infiltration of cells from glands are margins. 4=irregular masses of neoplastic cells with few glands. 5=lack of occasional glands, sheets of cells). takes 2 most common grades of cell and adds them together to make the gleason score. 
1=3+3 (insignificant, just keep an eye)
2=3+4
3=4+3
4=8
5=9-10

Question 16

treatment options for prostate ca

Answer 16

watchful waiting - usually in elderly or infirm. symptomatic treatment if they become symptomatic
active surveillance - presever QoL. watch and give treatment if get worse
Radical prostatectomy/radiotherapy - definitive treatment

Question 17

side effects of radiacal prostatectomy/radiotherapy

Answer 17

loss of sexual function (in up to 90%) and incontinence (5% at 1 year)

Question 18

which cancers usually metastasise to the bone

Answer 18

prostate 
kidneys 
lungs 
thyroid
breasts
(come in twos or 2 lobes)

Question 19

what is special about prostate bony mets

Answer 19

prostate sclerotic.

lung, kidney, thyroid, breast are lytic

Question 20

management of diagnosis of advanced prostate cancer (cauda equina)

Answer 20

catheter
degarelix (hormonal therapy - LHRH antagonist - immediate reduction in testosterone
dexmethosome 16mg initially then 4mg QDS

Question 21

risk factor for bladder ca

Answer 21

occupation (pain and rubber), older men, smoking

Question 22

main type of bladder ca

Answer 22

transitional
squamous - western world if have long term catheter, recurrent UTI,, stones. egypt - schistomtiasis
adenocarcinoma- urethral remnant

Question 23

2WW criteria for bladder ca

Answer 23

man over 40 with visible haematuria
over 60 unexplained non-visible haematuria and dysuria/raised WCC
consider non urgent referral if over 60 and recurrant UTI

Question 24

investigations for bladder ca

Answer 24

Cystoscopy
CT urogram (in visible haematuria)
TURBT - muscle invasiv or not? grade and staging

Question 25

treatment for high risk TCC bladder ca

Answer 25

BCG (injection?)