Renal system cancers

Question 1

What covers the prostatic urethra?

Answer 1

Transitional epithelium

Question 2

Where is the transitional zone of the prostate?

Answer 2

Surrounds prostatic urethra

Question 3

What does the transitional zone give rise to?

Answer 3

BPH

Question 4

What is the central zone of the prostate?

Answer 4

Cone shaped region surrounds the ejaculatory ducts

Question 5

Clinical presentation of prostate cancer

Answer 5

Haematuria/Haematospermia
Bone pain
Anorexia
Weight loss

Question 6

What is PSA?

Answer 6

Glycoprotein enzyme produced by the secretory epithelial cells of the prostate gland

Question 7

What is the function of PSA?

Answer 7

Involved in liquification of semen

Question 8

What can cause raised PSA?

Answer 8

Prostatitis/UTI
Retention
Cathererisation
DRE

Question 9

When is a PSA test indicated?

Answer 9

When patient has symptoms

Question 10

Indications for a TRUS biopsy?

Answer 10

Men with abnormal DRE and elevated PSA
Previous biopsies showing PIN or ASAP
Previous normal biopsies but rising PSA trends

Question 11

What type of cancer are 95% of prostate cancers?

Answer 11

Multifocal adeocarcinomas

Question 12

What are the most common sites for prostate metastases?

Answer 12

Pelvic lymph nodes

Skeleton

Question 13

Are metastases of prostate cancer sclerotic or lytic?

Answer 13

Sclerotic

Question 14

What system is used to grade prostate cancers?

Answer 14

Gleasons

Question 15

What imaging modalities can be used to stage prostate cancer?

Answer 15

Bone scan
MRI
CT scan

Question 16

Treatment options

Answer 16

Watchful waiting

Radical prostatectomy rADICAL RADIOTHERAPY

Question 17

Complications of radical prostatectomy

Answer 17

ED
Incontinence
Bladder neck stenosis

Question 18

When would hormonal therapy be used for prostate cancer?

Answer 18

Symptomatic patients who need palliation of symptoms unfit for curative

Question 19

Management of metastatic prostatic cancer

Answer 19

Androgen deprivation therapy (LHRH analogues, anti-androgens)
Steroids
Cytotoxic chemo

Question 20

What influences the growth of prostate cancer cell?

Answer 20

Testosterone

Dihydrotestosterone

Question 21

Sources of testosterone

Answer 21

Testis (90%)

Adrenal (10%)

Question 22

What happens if prostate cells are deprived of andorgenic stimulation?

Answer 22

They undergo apoptosis

Question 23

How do LHRH agonist work?

Answer 23

own regulate LHRH receptors with subsequent

Question 24

Why is anti-androgen given 1 week before and 2 weeks after LHRH agonists?

Answer 24

To prevent testosterone surge (can cause catastrophic spinal cord compression

Question 25

Side effects of LHRH agonists

Answer 25

``` Loss of libido/ED Hot flushes/sweats Weight gain Gynaecomastia Anaemia Cognitive changes Osteoporosis ```

Question 26

What is the action of anti-androgens?

Answer 26

Compete with testosterone and DHT for biding sites on prostate cell nucleus promoting apoptosis and inhibiting CaP growth

Question 27

What are the 2 types of anti-androgens?

Answer 27

Steroidal | Non-steroidal

Question 28

Which type of anti-androgen maintains sexual interest & libido?

Answer 28

Non-steroidal

Question 29

What are 90% of uroepithelial tumours?

Answer 29

Transitional cell

Question 30

Appearance of transitional cell carcinoma on imaging

Answer 30

HALO SIGN

Question 31

How are transitional cell cancers diagnosed?

Answer 31

CT urgram

Question 32

Examples of benign renal tumours

Answer 32

Renal cysts Oncocytoma Angiomyolipoma

Question 33

What is the embryonic tumour of the kidneys?

Answer 33

Nephroblastoma (Wilm's tumour)

Question 34

What is the main risk with renal angiomyolipomas?

Answer 34

Haemorrhage

Question 35

What would be seen on a CT f an oncocytoma?

Answer 35

Central scar

Question 36

What is the classic triad of renal cell carcinoma? (only present in 15%)

Answer 36

Loin pain Renal mass Haematuria

Question 37

What could multifocal or bilateral renal cell carcinoma be suggestive of?

Answer 37

Von Hippel-Lindau

Question 38

What is the gold stanard investigation for RCC?

Answer 38

CT contrast

Question 39

Which investigation has a high false negative in RCC?

Answer 39

Biopsy

Question 40

Where does RCC tend to metastasize?

Answer 40

Lungs Liver Bone Brain

Question 41

Management of RCC

Answer 41

Radical nephrectomy Partial nephrectomy Radiofrequency ablation

Question 42

What adjuvant therapy can be given in RCC

Answer 42

IL2 Interferon alpha Tyrosine kinase inhibitors (reduces neovascularisation)

Question 43

What is BXO?

Answer 43

Pre-malignant cutaneous lesion

Question 44

Managemetn of lichen sclerosis at atrophicus

Answer 44

Circumcision Meatal stenosis requiring dilation Glans resurfacing

Question 45

Examples of squamous cell carcinomas in situ on the penis?

Answer 45

Erthyroplasia of Queyrats Bowen's disease Zoon's balantis

Question 46

Treatment of squamous cell carcinoma in situ

Answer 46

Circumcision | Topical fluorouracil

Question 47

Presentation of invasive SCC of the penis

Answer 47

Red raised area Fungating mass Foul smelling Phimosis

Question 48

Which strain of HPV is linked to development of SCC of the penis

Answer 48

HPV 16

Question 49

In which testicular tumour is AFP never raised?

Answer 49

Seminoma

Question 50

Is a raised HCG more likely to be seminoma or teratoma?

Answer 50

Teratoma