renal, penile and testicular cancer

Question 1

renal tumours

Answer 1

1. renal cell carcinoma
2. oncocytoma
3. angiomyolipoma

Question 2

benign renal tumours

Answer 2

renal cysts, oncocytoma, angiomyolipoma, adenoma and fibroma

Question 3

malignant renal tumours

Answer 3

renal cell carcinoma

Question 4

embryonic renal tumour

Answer 4

nephrobalstoma (otherwise known as wilms tumour)

Question 5

most common presentation of renal tumours

Answer 5

found incidentally on ultrasound

Question 6

benign renal cysts

Answer 6

extremely common and the vast majority are benign, the increased the complexity of the cyst the more likely it is to be malignant

Question 7

angiomyolipoma

Answer 7

benign tumour which contains blood vessels, fat and muscle

Question 8

although angiomyolipoma is benign there is a risk of

Answer 8

haemorrhage

Question 9

angiomyolipomas are diagnosed using

Answer 9

CT to measure the density of the lesion which is reported in hounsefield units

Question 10

how many hounsefiedl units is diagnostic of an angiomyolipomas

Answer 10

greater than 10

Question 11

angiomyolipomas between 4-6cm

Answer 11

have a risk of spontaneous haemorrhage which can caused wunderlichs syndrome which is massive retro-peritoneal bleeding which can be fata therefore lesions of this size are embolized

Question 12

oncocytoma

Answer 12

benign renla tumour however, it cannot be differentiated from a renal cell carcinoma until after nephrectomy

Question 13

on ct of an oncocytoma

Answer 13

there is a central scar

Question 14

renal cell carcinoma classic triad

Answer 14

• renal mass
• frank haematuria
• loin pain

Question 15

frank haematuria is

Answer 15

urothelial carcinoma until proven otherwise however, after you have ruled it out part to rule out things like renal cell carcinoma

Question 16

renal cell carcinoma is a common cause of

Answer 16

paraneoplastic sydnromes

Question 17

renal cell carcinomas

Answer 17

arise from the epithelial cells of the proximal convoluted tubule

Question 18

renal cell carcinoma most common type

Answer 18

clear cell

Question 19

multi-focal or bilateral renal cell carcinoma should shout out

Answer 19

VON HIPPEL LINDAU SYDNROME

Question 20

Diagnosis of renal cell carcinoma

Answer 20

triple phase contrast CT which shows enhancement

Question 21

why is biopsy not carried out for renal cell carcinomas

Answer 21

because it doesn’t let you differentiate between a renal cell carcinoma and an oncocytoma

Question 22

Do renal cell carcinomas commonly extend outside the renal capsule

Answer 22

no they commonly spread into the renal veins and to the inferior vena cava where they metastasise to the lungs and bones

Question 23

treatment of renal cell carcinoma

Answer 23

gold standard is a radical nephrectomy where the whole kidney is removed as well as gerotas fascia but the adrenal gland is left in place unless it is involved

Question 24

renal cell carcinomas are not responsive to what

Answer 24

radiotherapy

Question 25

management of metastatic disease in renal cell carcinoma

Answer 25

surgery is still carried out where possible and tyrosine kinase inhibitors such as sunitinib

Question 26

pre-malingnat cutaneous penile conditions

Answer 26

- balanitis xerotica obliterates and leukoplakia

Question 27

spumous cell carcinoma of the penis is either

Answer 27

squamous cell carcinoma in situ or invasive squamous cell carcinoma

Question 28

balanitis xerotica obliterans is also known as

Answer 28

lichens sclerosis et atrophicus

Question 29

balnaitis xerotic obliterates usually present with

Answer 29

tight foreskin which cannot be retracted with a white demarcated line, causes fissuring and bleeding

Question 30

management of balanitis xerotica obliterates

Answer 30

circumcission

Question 31

balanitis xerotica obltierans has

Answer 31

a very low risk of becoming malignant and circumcission reduces this risk

Question 32

squamous cell carcinoma in situ presentation

Answer 32

red velvety patches on the pic or under the foreskin which do not go away

Question 33

squamous cell carcinoma in situ should be differentiated from

Answer 33

zoons ballonitis which only causes redness

Question 34

sqauous cell carcinoma in situ affecting the gland, prepuce or shaft is known as

Answer 34

erythropalsia of query

Question 35

anywhere else on the penis is known as

Answer 35

bowens disease

Question 36

treatment of squamous cell carcinoma in situ

Answer 36

if only the prepuce is involved circumcission but if any other part of the penis is involved topical- 5-fluoracil-

Question 37

invasive squamous cell carcinoma of the penis is often

Answer 37

a delayed presentation and present with a foul smell and phimosis

Question 38

diagnosis of invasive spumous cell carcinoma of the penis

Answer 38

ultrasound and MRI

Question 39

lymphadenopathy in invasive squamous cell carcinoma of the penis is

Answer 39

inguinal as the penis drains to the superficial inguinal nodes

Question 40

treatment of penis squamous cell carcinoma

Answer 40

partial or total penectomy and sentinel node biopsy

Question 41

testicular tumours

Answer 41

germ cell tumours: - seminoma - non-seminomatous germ cell tumours= teratomas, embryonal yolk sac and choriocarcinoma(all stem cell tumours) - intra-tubule germ cell neoplasms

Question 42

presentation of testicualr tumours

Answer 42

painless tessticualr swelling which is stony hard

Question 43

do testicualr tumours metastasise

Answer 43

yes 10% of people present with metastasis with supra-clavicular metastasis common

Question 44

diagnosis of testicualr tumours

Answer 44

ultrasound

Question 45

what else does a testiualr tumour require before carrying out surgery

Answer 45

chest x-ray to look for cannonball metastases

Question 46

tumour markers measures before surgery

Answer 46

- alpha foeto protein (AFP)= IS never elevated in a seminoma - beta-HCG= elevated in 10% seminomas and 60% of teratomas and is ALWAYS ELEVATED IN TROPHOBLAST TUMOURS - LDH= used to measure tumour burden

Question 47

treatment of testicualr tumour

Answer 47

orchidectomy through inguinal access and high ligation of the cord with insertion of a prosthetic testicle

Question 48

what is measured after orchidectomy

Answer 48

tumour markers

Question 49

where do the testis drain lympahticallt

Answer 49

to the para-aortic lymph nodes therefore, you cannot palpate lymph nodes in testicualr tumours