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Renal, tubular and penile cancer Flashcards

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1
Q

How do you catergorise renal masses?

A

Beingin and Malignant (renal cell cancer - cortex: solid/ cyctic). transitional cell carcinoma, lymphoma (elderly pop.)

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2
Q

What are cycts?

A

simple fluid filled lesion

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3
Q

Oncocytoma

A

spherical

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4
Q

Radioloigcal

A

radiologically v diff to differentiate frm ohter cancers

main feature: Central scar

doent metastasise

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5
Q

Presentation of onco

A

loin pain, haematuria

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6
Q

What is the treatment fro oncocytoma?

A

ifsmal – partial nephrectomy

large - radical nephrectomy

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7
Q

Angiomiolipoma

A

sporadic in middle aged females

20% occurs in association with Tuberous sclerosis (autosomal dominant, mental retardtaion, epilepsy, hamartomas)

80% of TS develop AML

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8
Q

WHat is AML haemo?

A

blood vesserls, muscle and fat

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9
Q

How does CT of AML look like?

A

simply observe it, fatty tymour of low density

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10
Q

Presentation of AML

A

sometime s massive loin pain and haematuria, mass

Wunderlich syndrome - 10% (massive retroperitoneal bleed0

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11
Q

Investigation

A

US - bright echo pattern,

CT _ fatty tumour

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12
Q

Treatment

A

1-2 cm men - doesnt matter

<4 cm in pre-menopausal women –> need to be monitored as during pregnancy they can grow in size

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13
Q

Elective treatment for AML

A

Embolization(to decrease risk of bleeding), partial nephrectomy

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14
Q

Emergency treatment

A

Emvbolisation and emergency nephrectomy

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15
Q

Renal cell carcinoma

A

Adenocarcinoma of the renal cortex

Arises from the PCT of the nephron

tan coloured- solid and lobulated in gross appearance

10-25% contain cysts –> cyctsic strucutres

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16
Q

Histological classifical of RCC

A
  1. Conventional clear cell carcinoma (Gene of chromosome 3, loss of VHl –> they are predisposed to developing RCC)
  2. Papillary - 10-15% have it, can be found as a multifocal disease, can develop tumours on the toher side as well

3, Chromophobe - similar to benign but malignant, low risk of metastases, 5%

  1. collecting duct: rare, young patients, oin medulla and collectin gduct, very aggressive, they present with metastases

5.

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17
Q

Grading of RCC

A

grading - malignant potential of the tumour

1-4 (differentiation levels)

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18
Q

Staging of the RCC

A

size and extense of cancer

shorter renal vein on the right, hence more in the right side

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19
Q

What is the most lethal of urological cancers?

A

RCC

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20
Q

Who is RCC more common in?

A

Men

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21
Q

Modifiable risk factors in RCC

A

smoking,
obesity
hypertension

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22
Q

Non-modifiable risk factor in RCC

A

renal failure and dialysis

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23
Q

Which

A

loss of tumour suppressor gene in chromosome 3

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24
Q

PC of RCC

A

haematuria, loin pain and mass

pyrexia
varicoceole (more so on the left side - left testicular vein goes directly into the renal vein, when the renal vein gets blocked by the tumour, it blocks the testicular vein as well -->

paraneoplastic syndrome- hormones and mass produced that can cause other symtpoms as well

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25
How are RCC found first?
Incidental finding
26
Investigatio
``` US - CT - kidney, abdomen and pelvis, chest --> to check ofr metastases FBC Renal and liver functions Clotting ```
27
Polycythaemia
erythropoetin
28
What is stauffer syndrome?
abnormal liver function tests, they settle down once
29
Treatment of RCC depends on what?
size and location
30
Treamtment for RCC < 3cm
less than 3cm - in old and frail --> just monitor them& and it is remains the same just leave it and keep checking 3-5 years young - selected partial nephrectomy old, healthy (either ablate with radiofrequency waves and burning the tumour, good cancer control in those < 3cm for 3-5 years ) radioablation in ppl fit elderly patient, selected younger apatients who are unfit
31
benign size
< 3cm
32
treatment >3cm
partial nephrectomy - more preferred in younger patients (40s - 50s), robotic technique Radical nephrectomy - laparoscopically remove the whole kidney, low morbidity post-op fit for surgery, 80 y/o, >3cm, healthy kidney - do radical nephrectomy
33
treatment for large tumours
radical nephrectomy
34
Risk in partial nephrectomy
bleeding
35
80 y/o, recent MI, tumour 2.5 cm
just monitor but if keep on something done - ablation
36
45 y/o tumour 2.5 cm | younger patient
partial nephrectomy - gold standard, ablation - optional
37
mass 7 cm
laparoscopic nephrectomy
38
tumour 15 cm
radical nephrectomy
39
How would you follow up in patients?
Risk categorise and chose accordingly, decrease radiation FBCand renal and liver function if it turns out t be a chromophobe --> clear cell - grade 2 -
40
What is the most common solid cancer in men 20-45?
testicular cancer
41
Seminomatous cancer
35-45 (surgeons)
42
Non-seminomatous. teratomas
<35 (troops)
43
what is the porgnosis of testicular cancer?
good
44
Common in whom?
White caucasians in europe and USA ***very very rare in africana or asians
45
Risk factors
contralateral testicle - previous testicular cancer crytpochordism orchidopexy before 13 y/i - 2x risk orcidopexy after 13 y/o - x% increased risk HIV - higher risk of seminoma Family history
46
Hisotological types of testicular
90% germ cells
47
PC of testicular cancer
scrotal lump in shower, delayed presentation can happen 5% acute pain - bleeding in the testis 10% - advacned disease including weihgt loss, neck lumps, chest symptoms or bone pain
48
On exam
always check the normal side first abnormal - assymetry, non-tender hard testicle, irregular mass mostly intra-testicular assymetry of slight scrota ldisclolouration assess epidydmis, spermatic cord and scrotal skin secondary hydrocoele abdominal mass - advanced disease
49
Investigations
US for the testicle CT chest abdomen for staging blood tests: serum tumour markers - AFP, B-HCG, LDH, raised in 50% cases not raised in all cases, and mostly in metastatic diseases it is raised FBC LFT Renal function tests
50
Treatment
Radical inguinal orchidectomy - inguinal approach, via inguinal canal, taking the testical out along as much length of the spermatic cord not from the scrotum - dont want to expose another way for the cancer to take
51
On exam
always check the normal side first abnormal - assymetry, non-tender hard testicle, irregular mass mostly intra-testicular assymetry of slight scrota ldisclolouration assess epidydmis, spermatic cord and scrotal skin secondary hydrocoele IMP********abdominal mass - advanced disease
52
Investigations
US for the testicle CT chest abdomen for staging - done anyway regardless of the abdominal mass blood tests: serum tumour markers - AFP, B-HCG, LDH, raised in 50% cases not raised in all cases, and mostly in metastatic diseases it is raised FBC LFT Renal function tests
53
Treatment
Radical inguinal orchidectomy - inguinal approach, via inguinal canal, taking the testical out along as much length of the spermatic cord not from the scrotum - dont want to expose another way for the cancer to take re-check tumour markers 1 weeks post op, if they are not going down do CT, further follow up oncologist --> some form of chemotherapy in lower doses given to increase prognosis
54
Penile cancer
squamous cell cancer 95% - skin cancer in the foreskin starts and then invades deeper into it Kaposi's sarcoma - HIV BCC, malignant melanoma and sarcoma - rare very rare
55
Risk factors in penile cancer
``` 5th- 6 th decade phimosis - chronic imflammation geography - asia, africa, south america more commonly seen HPV - strongly associated type 16 and 18 Smoking Immunocompromised patient ```
56
protective risk factor in penile cancer
circumsicion
57
most common location
glans - 48% | prepuce
58
PC
hard painless lump 15-50% - hihgh incidence of delayed presentation for > 1 year due to embarassment rare - urinalry retention or groin mass (inguinal lymphadenopathy)
59
Investigations
if small volume - not much done MRI - if the glans skin involved and the corpora might be involved then do MR, tumour death CT chest and abdomen - if advanced, if inguinal lymphadenopathy
60
Prognosis pof malignnay penile cancer in 5 years
0%
61
Treatment:
prepucial lesions - circumcision glans lesions - remove the skin over glans, put graft and let it take over, high risk that the undersurface of the foreskin in involved deep - glasectomy total penile amputation - supra-pubic catheter, inguinal lymph present - inguinal lymphadenopathy, might have tiny metastases

Renal (21 decks)

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