Renal, penile and testicular cancer Flashcards Preview

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Flashcards in Renal, penile and testicular cancer Deck (72)
1

How does an RCC spread/grow?

Grows into vena cava and can therefore metastasise to lungs
Can also spread to lymhatics

2

Sites of metastasis for RCC?

Lungs
Liver
Bone
Brain

3

RCC diagnosis?

USS
CT
Triple phase contrast
Biopsy
High false negative in RCC

4

What is an RCC? (histologically)

Adenocarcinoma of PCT
Clear cell, papillary

5

Adenocarcinoma of PCT
Clear cell, papillary

RCC

6

Von Hippel-lindau

Von Hippel-Lindau: an inherited disorder causing multiple tumours, both benign and malignant. Most common tumours are retinal and CNS hemangioblastomas. RCC, renal cysts and phaeochromocytoma

7

Classical triad of RCC?

Loin pain
Renal mass
Haematuria

8

Paraneoplastic syndrome associated with RCC?

Weight loss
Hypercalcemia
Anaemia
HT

9

Pre-malignant cutaneous lesions of penile cancer?

Balantitis xerotica obliterans, leukoplakia

10

Red raised area penis
Fungating mass
Foul smelling
Phimosis

Carcinoma of penis

11

HPV associated with penile carcinoma?

HPV16

12

Lymph nodes you should remove in penis cancer

Inguinal nodes

13

RCC adjuvant therapy?

IL2
Interferon alpha
Tyrosine kinase inhibitors
VEGF/PDGF inhibitors
-reduce neovascularisation
-26 months vs 20 months prognosis --> VERY GOOD

14

L2
Interferon alpha
Tyrosine kinase inhibitors
VEGF/PDGF inhibitors

Adjuvant therapy for RCC
-reduce neovascularisation
-26 months vs 20 months prognosis --> VERY GOOD

15

Chemical marker present in:
5-10% pure seminoma
Up to 60% teratoma

HCG

16

Chemical marker never raised in pure seminoma?

AFP

17

Chemical marker used to assess tumour burden?

LDH

18

Biggest risk factor for germ cell testicular tumours?

Undescended testes

19

Peak age incidence for testiculour tumours?

20-35 years

20

Marker for trophoblastic teratomas?

100% have elevated HCG

21

Robotis laparoscopy

Partial nephrectomy

22

Removal of whole kidney within Gerota's fascia
Perinephric fate

Radical nephrectomy

23

ECOG performance status

Shows how

24

Balantitis xerotica obliteran
Leukoplakia

Pre-malignant cutaneous lesions of penile cancer

25

Lichenus slerosus et atrophicus

Balantitis xerotica obliterans

26

Where does Erythroplasia of Queryat affect?

Glans, prepuce or shaft of penis
(Bowen's disease is the remainder of genitalia)

27

Red raised area on penis
Fungating mass, foul smelling
Phimosis

Carinoma of penis presentation

28

HPV associated with penis cancer

HPV 16

29

Most common pre-pubertal germ cell testicular tumour

Yolk sac tumour

30

When is AFP never raised?

Seminoma

31

When is HCG raised?

5-10% pure seminoma
Up to 60% teratoma

32

What does LDH show?

Tumour burden

33

Inguinal vs scrotum approach?

Inguinal because recurrence is lower than scrotum

34

Which type of teratoma is 100% associated with HCG?

Trophoblastic

35

Conditions associated with a raised PSA?

-Prostate cancer
-Benign prostatic hyperplasia
-Prostatitis/UTI's
-Retention
-Catheterisation
-DRE

36

Down sides of TRUS biopsy? (trans-rectal ultrasound guided biopsy)

-uncomfortable
-1 risk of significant sepsis and bleeding
-may need repeat biopsy

37

Indications for TRUS?

-Men with abnormal DRE, an elevated PSA
-Previous biopsies showing PIN or ASAP (basically weird cells)
-Previous normal biopsies but rising PSA trends

38

How many biopsies taken from the prostate?

10 biopsies taken (5 from each lobe)

39

Complications of TRUS?

Sepsis
Rectal bleeding
Vaso-vagal fainting
Haematospermia and haematuria for 2-3 weeks after the procedure

40

Most common sites for prostatic cancer metastasis?

Pelvic lymph nodes and the skeleton

41

Sclerotic lesions are characteristic of what?

Prostatic cancer

42

What is the Gleason scoring system based on when grading prostate cancer?

It is based on architectural appearance of the prostate glands rather than cytological features

43

Initial histological feature of prostate cancer?

Loss of basement membrane

44

The gleason score increases with what?

Increases with loss of the glandular structure and replacement by a disorganised malignant cell growth pattern

-The two most abundant cell patterns are assessed and then added together to give a score between 2 to 10

-Gleason's score is a very good predictor of prognosis and is therefore widely used

45

Transitional zone surrounds what

The urethra- gives rise to BPH

46

Which area gives rise to BPH?

The transitional zone

47

The central zone surrounds what?

The ejaculatory duct

48

Prostate cancer symptoms

Lower UTI symptoms
Haematuria/haematospermia
Bone pain, anorexia, weight loss

49

Are most prostate cancers unifocal or multifocal?

Multi focal

50

What is the initial feature of malignancy?

Loss of basement membrane

51

How does Gleason scoring work?

It is based on architectural appearance (not cytological features)
-graded from 1-5
-the 2 most abundant cell patterns are assessedd and added together to give a score between 2 and 10

52

T1

Clinically inapparent tumour not palpable or visible by imaging

53

T2

tumour confined within prostate

54

T3

Tumour extends through prostatic capsule

55

T4

Tumour fixed or invades adjacent structures other than seminal vesicles; bladder neck, external sphincter, rectum, levator muscles or pelvic wall

56

Imaging modalities for staging

Bone scan
MRI
CT scan

57

Organ confined disease

T1-2 N0 M0

58

Locally advanced disease

T3-4 N0 M0

59

Metastatic disease

N+ M+

60

Complications of radical surgery

Erectile dysfunction, incontinence, bladder neck stenosis

61

Complications of radical radiotherapy?

Irritative LUTS
Haematuria
GI symtpoms
Erectile dysfunction
Incontinence

62

Treatment for metastatic disease

Androgen deprivation therapy (Hormonal therapy: LHRH analogues, Anti-androgens)

63

Why do you give LHRH agonists in prostate cancer?

-eventually result in down regulation of LHRH receptors etc etc leads to decrease in testosterone - prostate not going to get any bigger/cell apoptosis :)

64

Side effects of LHRH agonists?

Loss of libido
Hot flushes and sweats
Weight gain
Gynaecomastia
Anaemia
Cognitive changes
Osteoporosis

65

How do anti-androgens work?

Compete with testosterone for binding sites
-promote apoptosis
-inhibit CaP growth

66

Steroid anti-androgen

Cyproterone acetate
(loss of libido, ED, gynaecomastia, cardiovascular toxicity, hepatotoxicity)

67

Non-steroidal anti-androgens

Nilutamide, flutamide, bicalutamide
SEXUAL INTEREST AND LIBIDO MAINTAINED
S/e gynaecomastia, breast pain and hot flashes hepatotoxicity

68

Cyprterone acetat

Steroidal anti-androgen

69

Nilutamide, flutamide and bicalutamide

Non-steroidal anti-androgens

70

Two types of transitional cell cancer

1) papillary
2) non papillary

A well differentiated papilloma is considered grade 1 papilloma

71

Urinary bladder HALO sign

Transitional cell carcinoma of bladder

72

Calcified bladder, which type of cancer?

Squamous