Renal, bladder and testis cancer

Question 1

which type of cancer accounts for 90% of renal cancers?

Answer 1

renal cell carcinoma

Question 2

What is the mean age of diagnosis for renal cancer?

Answer 2

55 yrs

Question 3

What is the name of the renal cancer that presents in children?

Answer 3

Wilms tumour

Question 4

What are some risk factors for renal cancer?

Answer 4

smoking
obesity
HTN

Question 5

What are the 5 common cancers which metastasise to bone?

Answer 5

Kidney
Breast
Bronchus
Prostate
Thyroid

Question 6

What are some features of renal carcinoma?

Answer 6

A lot of the time it is found incidentally.
Haematuria (50%)
Loin pain (40%)
Abdominal mass (25%)
Anorexia, malaise, weight loss, pyrexia of unknown origin

Question 7

What percentage of patients have metastases on presentation of renal cancer?

Answer 7

25%

Question 8

What is the gold standard imaging for renal cancer?

Answer 8

CT scan

Question 9

Treatment for renal cell carcinoma

Answer 9

Partial nephrectomy is gold standard for small tumours confined to the kidney
Radical nephrectomy
Palliative options
RCC does NOT respond to radiotherapy.

Patients with unresectable or metastatic disease
- High dose IL-2 and anti-angiogenesis agents

Question 10

Prognosis of RCC

Answer 10

Depends on SSIGN score

>10 score = 19.2% 10yr survival

Question 11

What are the most common type of bladder tumours?

Answer 11

90% are transitional cell carcinomas from transitional epithelium (urothelium)
SCC = 5%
Adenocarcinoma = 2% rare

Question 12

Are bladder tumours more common in men or women?

Answer 12

Men 5:2

8th most common cancer in men & very common in Sheffield

Question 13

What age is a bladder tumour rare?

Answer 13

<50

Question 14

Presentation of a bladder tumour?

Answer 14

Painless haematuria (85%)
LUTS - frequency, urgency, nocturia
Recurrent UTIs
Voiding irritability
Mass in lower abdomen, infiltrating prostate on DRE

Question 15

Things associated with bladder tumours?

Answer 15

• Smoking
• Aromatic amines (rubber industry)
• Hairdressers, leather workers, drivers, chemical workers
• Chronic cystitis
• Schistosomiasis (increased risk of SCC)
• Pelvic radiation
• Drugs - phenacetin (not used anymore - analgesic), cyclophosphamide, pioglitazone

Question 16

What are some investigations for haematuria?

Answer 16

Flexible cytoscopy - easy to perform, quick, 5% risk of UTI, well tolerated
Ultrasound KUB - less sensitive but safest
CT urogram - used for higher risk as involves radiation and contrast use
Urine cytology - rarely used. now

Question 17

Name causes of persistent NVH (common and less common urological and nephrological)

Answer 17

Common urological
- BPH
- cancer
- stones disease
- infection
Less common urological
- Radiation cystitis
- urethral stricture
- medullary spongy kidney
Nephrological
- IgA nephropathy
- Thin basement membrane disease
- Glomerulonephritis
- Vasculitis

Question 18

What is the difference between staging and grading of a cancer?

Answer 18

Grading - how it looks microscopically

Staging - where the cancer has spread to or gone.

Question 19

Treatment of TCC of the bladder

Answer 19

Low grades - transurethral resection of bladder tumour (TURBT) is both diagnostic and therapeutic.
T2-T3 = radical cystectomy is the gold standard
T4 = usually palliative chem or radiotherapy

Question 20

What are some risks associated with transurethral resection of bladder tumour procedure?

Answer 20

Pain
Infection
Bladder perforation

Question 21

How often do we follow up on high risk and low risk bladder tumours?

Answer 21

High risk: cytoscopy every 3m for 2 yrs then every 6m

Low risk: cytoscopy follow up 9m then yearly.

Question 22

What is the most common procedure used for urinary diversion?

Answer 22

Ileal conduit

Question 23

Is it true that a testicular lump is cancer until proven otherwise?

Answer 23

Yes

Question 24

Acute, tender enlargement of the testis is what until proven otherwise?

Answer 24

Torsion

Question 25

At what age do epididymal cysts usually occur? Where are they found?

Answer 25

Develop in adulthood | Lie behind and above the testis

Question 26

What are the causes, features and treatment for epididymo-orchitis?

Answer 26

Causes - Chlamydia <35yrs, E.coli, mumps, N. gonorrhoea, TB Features - Sudden-onset tender swelling - Dysuria - Sweats or fever - First catch urine sample may contain urethral discharge - Possible infertility and symptoms may worsen before improving Treat - If <35 = doxycycline - If gonorrhoea suspected add ceftriaxone - If >35, associated UTI common so try ciprofloxacin - Analgesia, scrotal support, drainage of any abscess

Question 27

What is a variocele?

Answer 27

- Dilated veins of pampiniform plexus - Left side more commonly affected - Often visible as distended scrotal blood vessels that 'feel like a bag of worms' - Patient may complain of dull ache - Subfertility association

Question 28

When do testicular tumours most commonly present? What treatment are testicular tumours really sensitive to? 90% of them are what type of tumours? Signs? Risk factors?

Answer 28

- Most common malignancy in men aged 20-45 - 10% occur in undescended testes, even after orchidopexy - Most curable cancer - extremely sensitive to chemotherapy - Bilateral in 1-2% - 90% are germ cell tumours Signs - Typically painless, testicular lump found after trauma or infection → request ultrasound if anything strange going on in testicle - Hard mass arising from testes, check lymph nodes, abdomen and lungs - Secondary hydrocele - Pain sometimes - Dyspnoea (lung mets) - Abdominal mass (enlarged nodes) Risk factors - Undescended testes - Infant hernia - Infertility - Previous testicular cancer - HIV increases risk of seminoma - Positive family history increases risk

Question 29

Tests for testicular tumours? | What are some useful markers for testicular tumours?

Answer 29

Scrotal USS to be done on the day CXR and CTAP Excision biopsy a-FP and b-hCG and LDH are useful markers and help monitor the treatment (LDH produced in tumour necrosis)

Question 30

Treatment for testicular tumours? What should we encourage to help prevent late presentation of testicular cancer?

Answer 30

- Radical inguinal orchidectomy → definitive diagnosis and curative in 75% - Chemotherapy → Very sensitive to platinum based chemo, used for high risk or metastatic disease - Retroperitoneal lymph node dissection → In UK only used to de-bulk residual LN masses after chemo - Encourage regular self-examination (prevents late presentation)