Session 9 - Cancers of the Urinary System Flashcards Preview

Semester 3 - Urinary > Session 9 - Cancers of the Urinary System > Flashcards

Flashcards in Session 9 - Cancers of the Urinary System Deck (44):
1

Name three main risk factors for prostate cancer

• Age
• Family history
• Race

2

How is age a risk factor for prostate cancer?

• There is a correlation with increasing age
• Uncommon in men younger than 50

3

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

4

How is prostate cancer related to race?

• Incidence in asian < Caucausian < Afro-Carribean

5

Give the usual presentation of prostate cancer

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

6

Give an unusual symptom of prostate cancer

haematuria

7

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

8

Give 5 factors influencing treatment decisions in prostate cancer

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

9

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

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

10

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

• Gleason grade

11

What is a Gleason grading?

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

12

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

13

Give three treatments for developmental prostate cancers

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

14

How can metastatic prostate cancer be treated?

• Hormones
○ Surgical castration, medical castration
• Palliation

Single-dose radiotherapy, bisphosphonates, chemotherap

15

Give three ways to treat locally advanced prostate cancer

• Surveillance
• Hormones
• Hormones & radiotherapy

16

What is haematuria?

• Blood in urine
• Classified as visible or non-visible

17

What does it mean if haematuria is visible?

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

18

What does it mean if haematuria is non-visible?

• Can be symptomatic or asymptomatic

Detected via microscopy or urine dipstick

19

Give three causes of haematuria

• Cancer
• Other

Nephrological

20

Give four types of cancer which can cause haematuria

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

21

Give five non-cancerous causes of haematuria

• Stones
• Infection
• Inflammation
• Benign prostatic hyperplasi

Nephrological

22

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

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

23

What should be looked for on examination of someone with haematuria

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

24

What investigations should be done for haematuria?

• Urine culture
• Cytology
• FBC
• Ultrasound
• Flexible cystoscopy

25

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

26

Give three large risk factors for bladder cancer

• Smoking
• Occupational exposure
• Schistomiasis

27

How much does smoking increase risk of bladder cancer?

• 4x increased risk

28

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

29

Outline the staging of bladder cancer

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

30

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

31

Give two treatments for high risk non-muscle invasive TCC

• Check cystoscopies
• Intravesical chemotherapy/immunotherapy

32

Give a treatment for low risk non-muscle invasive TCC

• Check cystoscopies

33

Give two courses of treatment for muscle invasive TCC

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

34

What is a radical cystectomy?

• Removal of the urinary bladder

35

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

36

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

37

Give three risk factors for RCC

• Smoking
• Obesity
• Dialysis

38

Where does RCC mestatasise to?

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

39

What is the established treatment for RCC?

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

40

Give a developmental treatment for RCC

• Ablation
○ Removal of tumour via erosive process

41

Give two palliative treatments for RCC

• Molecular therapies targeting angiogenesis
• Immunotherapy

42

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

43

Give four investigations for Upper Tract TCC

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

44

What is the treatment for upper tract TCC?

• Nephro-ureterectomy

Removal of the kidney, fat, ureter and cuff of bladder