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2MB Renal > Tumours > Flashcards

Tumours Flashcards

1
Q

List the main benign renal tumours

A

Fibroma
Adenoma
Angiomyolipoma
Juxtaglomerular cell tumour (JGCT)

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2
Q

Which area of the kidney do fibromas originate from?

A

Medulla

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3
Q

Which area of the kidney do adenomas originate from?

A

Cortex

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4
Q

Which condition is associated with angiomyolipoma?

A

Tuberous sclerosis

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5
Q

JGCT can cause primary hypertension. True/False?

A

False

Secondary hypertension; secrete renin

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6
Q

List the main malignant renal tumours

A

Nephroblastoma
Urothelial carcinoma
Renal cell carcinoma

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7
Q

Which malignant renal tumour is commonest in children and adults?

A

Nephroblastoma in children

Renal cell carcinoma in adults

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8
Q

Where do nephroblastoma arise from?

A

Residual primitive renal tissue

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9
Q

Where do renal cell carcinoma arise from?

A

Renal tubular epithelium

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10
Q

List clinical features of renal cell carcinoma

A 
Abdominal mass
Haematuria
Flank pain
Hypercalcaemia
Polycythemia (raised RBC)
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11
Q

Renal vein extension is common in renal cell carcinoma. True/False?

A

True

Can extend into vena cava and right atrium

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12
Q

Which type of renal cell carcinoma is the most common?

A

Clear cell type - rich in glycogen and lipid

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13
Q

Which malignant tumour affects the area between the pelvicalyceal system to the urethra?

A

Transitional cell carcinoma (of transitional epithelium)

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14
Q

List risk factors for transitional cell carcinoma

A

Dyes
Rubber industry
Cyclophosphamide
Smoking

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15
Q

Where do 75% of transitional cell carcinomas occur?

A

Region of trigone, leading to ureteric obstruction

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16
Q

What is the main tumour that affects the penis?

A

Squamous cell carcinoma in situ

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17
Q

Which group of individuals are particularly susceptible to squamous cell carcinoma of the penis?

A

Uncircumcised men

Also note poor hygiene + HPV infection

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18
Q

What occupation was linked with SCC of the scrotum?

A

Chimney sweeps

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19
Q

At least 75% of men over 70 are affected by benign nodular hyperplasia of prostate. True/False?

A

True

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20
Q

What is the proposed aetiology behind benign nodular hyperplasia of prostate (BNH)?

A

Hormone imbalance - androgen decreases as get older but oestrogen level remains same; gland is oestrogen responsive

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21
Q

List clinical features of BNH of prostate and general prostatism

A

Difficulty in starting micturition
Poor stream
Overflow incontinence

22
Q

How is BNH of prostate managed?

A

Surgery - transurethral resection

Drugs - alpha blocker, 5-alpha-reductase inhibitor

23
Q

BNH of prostate is pre-malignant. True/False?

A

False

24
Q

Carcinoma of prostate is associated with BNH of prostate. True/False?

A

False

Not associated but both can occur at once

25
Q

Why do symptoms of carcinoma of prostate only arise when the disease is more advanced?

A

Carcinoma arises in peripheral ducts and glands, so peri-urethral (bladder obstructive) area is involved at later stage

26
Q

What effect can prostate carcinoma have on bone?

A

Osteosclerotic metastases

27
Q

List investigations for prostate carcinoma

A

PR exam
Ultrasound/XR
Prostate Specific Antigen (PSA)
Biopsy

28
Q

List management for prostate carcinoma

A

Anti-androgen drug
Radiotherapy if bone metastases
Surgery (prostatectomy)

29
Q

State a major risk factor for developing testicular tumour

A

Testicular maldescent

30
Q

How do testicular tumours usually present?

A

Painless testicular enlargement

31
Q

Name the most common class of testicular tumour

A

Germ cell tumour (seminoma, teratoma)

32
Q

What is the commonest germ cell tumour?

A

Seminoma

33
Q

Seminomas are very rare before puberty. True/False?

A

True

34
Q

Which tumour marker is useful for identifying seminoma?

A

Placental alkaline phosphatase (PLAP)

35
Q

List the zonal anatomy of the prostate in order of most-least % origin of prostate cancer

A

Peripheral (70%)
Transitional (20%)
Central (5%)

36
Q

Which zone of the prostate gives rise to benign prostate hyperplasia?

A

Transitional zone

37
Q

List abnormal findings of a digital rectal exam that could indicate prostate cancer

A

Asymmetry
Nodule
Hard, craggy mass

38
Q

Which marker is usually used to detect prostatic disease?

A

PSA (prostate specific antigen)

39
Q

Where is PSA produced?

A

Enzyme produced by secretory epithelial cells of prostate gland, involved in liquefying semen

40
Q

In healthy people serum PSA is high. True/False?

A

False
Semen levels of PSA are high but serum is normal in normal people
High PSA in serum suggests cancer

41
Q

Is specificity of PSA for cancer high or low?

A

Low (40%)

Can be raised in prostatitis, UTI, catheterisation

42
Q

How is a biopsy of prostate cancer taken?

A 
Trans-rectal ultrasound-guided approach
10 biopsies (5 from each lobe) taken
43
Q

What is the majority of prostate cancer?

A

Multifocal adenocarcinoma

44
Q

What are the most common sites for prostate adenocarcinoma metastasis?

A

Pelvic lymph nodes

Skeleton (osteosclerosis)

45
Q

Which score is used to grade prostate malignancy?

A

Gleason score

Also use bone scan/MRI/CT

46
Q

Outline management of organ-confined prostate cancer

A

Watchful waiting/symptom-guided

Active monitoring

47
Q

Outline management of locally-advanced prostate cancer

A

Radiotherapy + hormonal therapy

48
Q

Outline management of metastatic prostate cancer

A

Androgen-deprivation therapy
Steroids
Cytotoxic chemotherapy

49
Q

How do LHRH agonists provide hormonal therapy in prostate cancer?

A

Stimulate pituitary to increase LH/FSH which increases testosterone

50
Q

What is the majority of urothelial tumours?

A

Transitional cell carcinoma

51
Q

Most transitional cell carcinoma is papillary. True/False?

A

True

20% non-papillary

2MB Renal (16 decks)

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