The forbidden cancers Flashcards
Bladder cancer presentation
Urothelial (transitional cell) carcinoma (>90% of cases)
Squamous cell carcinoma ( 1-7% -except in regions affected by schistosomiasis)
Adenocarcinoma (2%)
Risk factors for urothelial (transitional cell) carcinoma of the bladder include:
Smoking
most important risk factor in western countries
hazard ratio is around 4
Exposure to aniline dyes
for example working in the printing and textile industry
examples are 2-naphthylamine and benzidine
Rubber manufacture
Cyclophosphamide
Risk factors for squamous cell carcinoma of the bladder include:
Schistosomiasis
Smoking
Frank heamaturia–Most patients (85%) will present with painless, macroscopic haematuria.
Bladder cancer ix
GS–
Most will undergo a cystoscopy
and biopsies or TURBT, this provides histological diagnosis and information relating to depth of invasion. Locoregional spread is best determined using pelvic MRI and distant disease CT scanning. Nodes of uncertain significance may be investigated using PET CT.
Bladder cancer mx
Those with superficial lesions may be managed using TURBT in isolation–trans urethral resection of bladder tumour
Those with recurrences or higher grade/ risk on histology may be offered intravesical chemotherapy. Those with T2 disease are usually offered either surgery (radical cystectomy and ileal conduit) or radical radiotherapy.
Renal cancer presentation and ix
Renal cell cancer is also known as hypernephroma and accounts for 85% of primary renal neoplasms. It arises from proximal renal tubular epithelium. The most common histological subtype is clear cell (75 to 85 percent of tumours).
Associations
more common in middle-aged men
smoking
Tuberous sclerosis
classical triad:
haematuria
loin pain
abdominal mass
varicocele
Ix-
may secrete erythropoietin (polycythaemia)
parathyroid hormone-related protein (hypercalcaemia), renin
ACTH
Diagnosis is usually suggested by ultrasound
Contrast-enhanced abdominal imaging is the definitive test for diagnosis and staging of RCC
Renal cell cancer management
for confined disease a partial or total nephrectomy depending on the tumour size
patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy
alpha-interferon and interleukin-2 have been used to reduce tumour size and also treat patients with metatases
t1/2 in kidney (just <7cm or >7cm)
T3/4 outside
Testicular cancer RF, Presentation
Around 95% of cases of testicular cancer are germ-cell tumours. Germ cell tumours may essentially be divided into:
seminomas
non-seminomas: including embryonal, yolk sac, teratoma and choriocarcinoma
Non-germ cell tumours include Leydig cell tumours and sarcomas.
The peak incidence for teratomas is 25 years and seminomas is 35 years. Risk factors include:
infertility (increases risk by a factor of 3)
cryptorchidism
family history
a painless lump is the most common presenting symptom
pain may also be present in a minority of men
hydrocele
gynaecomastia
this occurs due to an increased oestrogen:androgen ratio
Testicular cancer Ix and mx
germ cell tumours
seminomas: seminomas: hCG may be elevated in around 20%
non-seminomas: AFP and/or beta-hCG are elevated in 80-85%
LDH is elevated in around 40% of germ cell tumours
Diagnosis
ultrasound is first-line
Management
treatment depends on whether the tumour is a seminoma or a non-seminoma
orchidectomy
chemotherapy and radiotherapy may be given depending on staging and tumour type
great prognosis
Prostate cancer presentation
Localised prostate cancer is often asymptomatic. This is partly because cancers tend to develop in the periphery of the prostate and hence don’t cause obstructive symptoms early on.
bladder outlet obstruction: hesitancy, urinary retention
haematuria, haematospermia
pain: back, perineal or testicular
digital rectal examination: asymmetrical, hard, nodular enlargement with loss of median sulcus
PSA- but care with-
exercise, BPH
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
DRE
multiparametric MRI as a first-line investigation. TRUS (biopsy isnt)
If the Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered
Prostate cancer management
Localised prostate cancer (T1/T2)
Treatment depends on life expectancy and patient choice. Options include:
conservative: active monitoring & watchful waiting
radical prostatectomy
radiotherapy: external beam and brachytherapy
Localised advanced prostate cancer (T3/T4)
Options include:
hormonal therapy: see below
radical prostatectomy: erectile dysfunction is a common complication
radiotherapy
external beam and brachytherapy
Metastatic prostate cancer disease - hormonal therapy
Synthetic GnRH agonist or antagonists
GnRH agonists: e.g. Goserelin (Zoladex)
initially therapy is often covered with an anti-androgen to prevent a rise in testosterone - ‘tumour flare’. The resultant stimulation of prostate cancer growth may result in bone pain, bladder obstruction and other symptoms
bicalutamide
non-steroidal anti-androgen
blocks the androgen receptor
bilateral orchidectomy
used to rapidly reduce testosterone levels
chemo
Cholangiocarcinoma
ad
Breast cancer
bad
Leukemia
as
Lymphoma
sad
head and neck cancer
Thyroid cancer
