Flashcards in Session 9 - Cancers of the Urinary System Deck (44)
Name three main risk factors for prostate cancer
• Family history
How is age a risk factor for prostate cancer?
• There is a correlation with increasing age
• Uncommon in men younger than 50
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
How is prostate cancer related to race?
• Incidence in asian < Caucausian < Afro-Carribean
Give the usual presentation of prostate cancer
• Vast majory asymptomatic
• Urinary symptoms
○ Benign enlargement of prostate
○ Bladder over activity
○ +/- CaP
• Bone pain
○ Advanced metastatic
Give an unusual symptom of prostate cancer
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
Give 5 factors influencing treatment decisions in prostate cancer
• Digital Rectal Exam
• PSA level
• MRI scan and bone scan
What are the three different results you can get from a digital rectal exam?
• Localised (T1/2)
• Locally advances (T3)
• Advanced (T4)
What can biopsies tell us about the advancement of prostate cancer?
• Gleason grade
What is a Gleason grading?
• Pathologist adds together grading score of most common cell type and adds to highest graded prostate tissue
Give three treatments for established prostate cancer
○ Watch cancer, tumor not severe enough to outweigh risks of treatment
• Radical prostateectomy
Radiotherapy - External beams or low dose brachytherapy
Give three treatments for developmental prostate cancers
• High intensity focused ultrasound
• Primary cryotherapy - freeze the prostate
• Brachytherapy - High dose (small rods implanted in prostate)
How can metastatic prostate cancer be treated?
○ Surgical castration, medical castration
Single-dose radiotherapy, bisphosphonates, chemotherap
Give three ways to treat locally advanced prostate cancer
• Hormones & radiotherapy
What is haematuria?
• Blood in urine
• Classified as visible or non-visible
What does it mean if haematuria is visible?
• On investigation there is a 20% chance a malignancy is present
What does it mean if haematuria is non-visible?
• Can be symptomatic or asymptomatic
Detected via microscopy or urine dipstick
Give three causes of haematuria
Give four types of cancer which can cause haematuria
• Renal cell carcinoma
• Upper tract transition cell carcinoma
• Bladder cancer
• Advanced prostate cancer
Give five non-cancerous causes of haematuria
• Benign prostatic hyperplasi
What questions must be taken on investigating the history of someone with haematuria?
• Pain levels
• Other UTI symptoms
• Family history
What should be looked for on examination of someone with haematuria
• 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?
• Urine culture
• 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
• Occupational exposure
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
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?
• Radical nephrectomy
○ Removal of kidney, adrenal, surrounding fate and upper ureter
• Partial nephrectomy
Give a developmental treatment for RCC
○ Removal of tumour via erosive process
Give two palliative treatments for RCC
• Molecular therapies targeting angiogenesis
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
• CT urogram
• Retrograde pyelogram (inject contrast into ureter)
○ Washings for cytology