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Flashcards in Renal system malignancies Deck (53):
1

Area ejaculatory ducts drain into

Verumontanum

2

Transitional zone of prostate

Surrounds prostatic urethra
Gives rise to BPH

3

Peripheral zones of prostate

Posterolateral
Most prostate cancers

4

Central zone

Surrounds ejaculatory ducts

5

Most common malignancy affecting men in the UK

Prostate cancer

6

Most common in who?

70-74 years
Western world
Black
FH

7

Presentation of prostate cancer

Usually asymptomatic - picked up by PSA
Haematuria, haematospermia
Bone pain, anorexia, weight loss

8

What is PSA?

Glycoprotein produced by epithelial cells of prostate

9

Serum and semen levels of PSA

In health: semen levels high, serum levels low
In cancer: serum levels high

10

Other conditions which elevate PSA?

BPH
Prostatitis/UTI
Retention
Catheter
PR exam

11

Investigations for prostate cancer

PR exam
PSA
Transrectal US and biopsy
Bone scam, MRI, CT for staging

12

What type are most prostate cancers?

Multifocal adenocarcinomas

13

Most common prostatic mets

Spine - sclerotic
Pelvic nodes

14

What scoring system used for prostate cancer grading?

Gleason's score - based on appearance

15

Appearance of prostate cancer

Loss of basement membrane then loss of glandular structure

16

Treatment of prostate cancer

Watchful waiting
Surgery
Chemotherapy
Radiotherapy
Hormonal therapy

17

Hormonal control of prostate

Under influence of testosterone
Deprived of testosterone = apoptosis

18

Types of hormonal therapy

LHRH agonists
Anti-androgens

19

How do LHRH agonists work?

Chronic exposure results in downregulation of LHRH receptors = suppression of LH and FSH and suppression of testosteron
Provide anti-androgen for 3 weeks due to initial increase

20

Side effects of LHRH agonists

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

21

How do anti-androgens work?

Compete with testosterone for receptors = apoptosis of cancer cells

22

Side effects of anti-androgens

Steroidal: loss of libido, ED, gynaecomastia, hepatotoxic, cardiotoxic
Non-steroidal: gynaecomastia, hot flashes, hepatotoxic

23

Diagnosis of bladder cancer

Xray
Uroscopy
CT

24

Types of bladder cancer

Transitional cell 90%
SCC 9%

25

Types of transitional cell cancer

Papillary - 50% are malignant
Non-papillary - all are malignant

26

Appearance of transitional cell cancer

Multicentric
Bilateral

27

Who gets bladder cancer?

Males >50

28

Angiomyolipoma

Benign
Hamartoma: fragile BVs, fat, smooth muscle

29

How to diagnose angiomyolipoma

CT
Biopsy (dangerous due to haemorrhage)

30

Treatment of angiomyolipoma

Embolisation if bleed

31

Oncocytoma

Benign, can look like malignant RCC
Central scar on CT

32

Diagnosis of oncocytoma

CT central scar (strands radiate out)
Nephrectomy - high false negative rate of malignant

33

Presentation of RCC

Loin pain
Renal mass
Frank haematuria
Paraneoplastic: weight loss, bone pain, anaemia, HT, hypercalcaemia

34

Who gets RCC?

Males 65-75

35

Types of RCC

Adenocarcinoma of PCT
Carcinoma (epithelial)
Clear cell and papillary
CD adenocarcinoma

36

Syndrome which may lead to multiple, bialteral renal tumorus

VHL

37

Diagnosis of RCC

US
CT
Biopsy

38

How does RCC spread?

Haematogenous via renal vein
Mets to lung, liver, bone, brain

39

Treatment of RCC

Surgery - total/partial nephrectomy
Biological therapies

40

BXO

Balanitis Xerotica Obliterans
Pre-malignant lesion
Scarring of foreskin and up urethra, white demarcated line
White patches, bleeding, pain

41

Treatment of BXO

Circumcision
Dilatation
Glans resurfacing, skin graft

42

SCC of penis in situ

Red velvety patches
Bowen's or Queyrat's (pre-malignant) = 5FU or circumcision

43

Invasive SCC of penis

Older men, red raised area, fungating mass, foul smelling, phimosis (narrowing)
HPV 16

44

Treatment of invasive SCC of penis

Surgery
Chemo
Radio
Nodes

45

Germ cell tumours of testicles

Seminoma
Teratoma
ITGCN (intra-tubular germ cell neoplasia)

46

Presentation of testicular cancer

Painless swelling, hard
Neck nodes, SOB, clavicular nodes

47

Diagnosis of testicular cancer

US
CXR
CT

48

AFP marker

Raised in teratoma with yolk sac elements

49

HCG marker

Raised in teratoma with trophoblast components

50

LDH and placental ALP markers

Raised in seminoma

51

Who gets testicular cancer?

20-35 years
Undescended testes

52

Where does testicular cancer mets to?

Kidneys

53

Treatment of testicular cancer

Radiotherapy
Chemotherapy
Surgery