Blood in urine Classified as visible or non-visible

Session 9 - Cancers of the Urinary System Flashcards by Matt Quinn

Name three main risk factors for prostate cancer

Age
- Family history
- Race

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How is age a risk factor for prostate cancer?

There is a correlation with increasing age

* Uncommon in men younger than 50

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How is family history a risk factor for prostate cancer?

4x increased risk
- If one 1st degree relative is diagnosed with prostate cancer before age 60
- After 60 diagnosis probably age related

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How is prostate cancer related to race?

• Incidence in asian < Caucausian < Afro-Carribean

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Give the usual presentation of prostate cancer

• Vast majory asymptomatic
	• Urinary symptoms
		○ Benign enlargement of prostate
		○ Bladder over activity
		○ +/- CaP
	• Bone pain 
		○ Advanced metastatic

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Give an unusual symptom of prostate cancer

haematuria

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Outline how prostate cancer is diagnosed

• A digital rectal examination
• A serum PSA
○ Used to assess wether or not a biopsy in necessary
• If it is, carried out via a TransRectal UltraSound guided biopsy of prostate
• Lower urinary tract symptoms are treated with a TransUrethral Resection of Prostate

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Give 5 factors influencing treatment decisions in prostate cancer

MADBP
	• Age
	• Digital Rectal Exam
	• PSA level
	• Biopsies
	• MRI scan and bone scan

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What are the three different results you can get from a digital rectal exam?

Localised (T1/2)
- Locally advances (T3)
- Advanced (T4)

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What can biopsies tell us about the advancement of prostate cancer?

• Gleason grade

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What is a Gleason grading?

• Pathologist adds together grading score of most common cell type and adds to highest graded prostate tissue

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Give three treatments for established prostate cancer

• Surveillance
○ Watch cancer, tumor not severe enough to outweigh risks of treatment
• Radical prostateectomy

Radiotherapy - External beams or low dose brachytherapy

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Give three treatments for developmental prostate cancers

High intensity focused ultrasound
- Primary cryotherapy - freeze the prostate
- Brachytherapy - High dose (small rods implanted in prostate)

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How can metastatic prostate cancer be treated?

• Hormones
○ Surgical castration, medical castration
• Palliation

Single-dose radiotherapy, bisphosphonates, chemotherap

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Give three ways to treat locally advanced prostate cancer

Surveillance
- Hormones
- Hormones & radiotherapy

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What is haematuria?

Blood in urine

* Classified as visible or non-visible

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What does it mean if haematuria is visible?

• On investigation there is a 20% chance a malignancy is present

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What does it mean if haematuria is non-visible?

Study These Flashcards

• Can be symptomatic or asymptomatic

Detected via microscopy or urine dipstick

Give three causes of haematuria

Study These Flashcards

Cancer
- Other

Nephrological

Give four types of cancer which can cause haematuria

Study These Flashcards

Renal cell carcinoma
- Upper tract transition cell carcinoma
- Bladder cancer
- Advanced prostate cancer

Give five non-cancerous causes of haematuria

Study These Flashcards

Stones
- Infection
- Inflammation
- Benign prostatic hyperplasi

Nephrological

What questions must be taken on investigating the history of someone with haematuria?

Study These Flashcards

Smoking
- Occupation
- Pain levels
- Other UTI symptoms
- Family history

What should be looked for on examination of someone with haematuria

Study These Flashcards

BP
- Abdominal mass
- Varicocele – collection of veins in the scrotum (‘bag of worms’)
- Leg swelling
- Assess prostate by DRE (male) – Size, texture

What investigations should be done for haematuria?

Study These Flashcards

Urine culture
- Cytology
- FBC
- Ultrasound
- Flexible cystoscopy

Outline the epidemiology of bladder cancer

* 7th most common cancer in the UK, but incidence decreasing] * Male to female ratio 2.5:1 and 90% are transitional cell carcinomas

Give three large risk factors for bladder cancer

* Smoking * Occupational exposure * Schistomiasis

How much does smoking increase risk of bladder cancer?

• 4x increased risk

Give three examples of occupational exposure increasing risk of bladder cancer

* Rubber or plastics manufacture (arylamines) * Handling of carbon, crude oil, combustion (polyaromatic hydrocarbons) * Painters, mechanics, printers, hairdressers

Outline the staging of bladder cancer

* 75% of cancers are superficial * 5% are in situ * 20% are muscle invasive

Give three types of bladder cancer which all have different treatments

* High risk non-muscle invasive TCC (transitional cell carcinoma, you simpleton) * Low risk non-muscle invasive TCC Muscle invasive TCC

Give two treatments for high risk non-muscle invasive TCC

* Check cystoscopies | * Intravesical chemotherapy/immunotherapy

Give a treatment for low risk non-muscle invasive TCC

• Check cystoscopies

Give two courses of treatment for muscle invasive TCC

• Potentially curative ○ Radical cystectomy or radiotherapy (+/- chemotherapy) ○ Not curative • Palliative chemotherapy/radiotherapy

What is a radical cystectomy?

• Removal of the urinary bladder

What can be done after a radical cystectomy to simulate a bladder?

* A piece of ileum may be used to make a conduit from the ureters to the abdomen, where urine can be collected in a bag * May also attempt to reconstruct the bladders from a piece of small intestine

Outline the epidemiology renal cell carcinoma

* 8th most common cancer in the UK, making up 95% of all upper urinary tract tumours * Male to female ratio of 3:2 and 30% have metastases on presentation

Give three risk factors for RCC

* Smoking * Obesity * Dialysis

Where does RCC mestatasise to?

* Lymph nodes * Up the renal vein * Vena cava into right atrium * Into subcapsular fat (perinephric spread)

What is the established treatment for RCC?

• Surveillance • Radical nephrectomy ○ Removal of kidney, adrenal, surrounding fate and upper ureter • Partial nephrectomy

Give a developmental treatment for RCC

• Ablation | ○ Removal of tumour via erosive process

Give two palliative treatments for RCC

* Molecular therapies targeting angiogenesis | * Immunotherapy

What is the epidemiology of Upper Tract Transitional Cell Carcinoma (TCC)

* Only 5% of malignancies of URT (Rest are RCC) * 5% due to spread of cancer from bladder * 40% of cancers of the URT spread to bladder

Give four investigations for Upper Tract TCC

``` • Ultrasound • CT urogram • Retrograde pyelogram (inject contrast into ureter) • Ureteroscopy ○ Biopsy ○ Washings for cytology ```

What is the treatment for upper tract TCC?

• Nephro-ureterectomy Removal of the kidney, fat, ureter and cuff of bladder

Session 9 - Cancers of the Urinary System Flashcards

(44 cards)