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Flashcards in Tumours Deck (34):
1

what type of cancer is renal cell carcinoma? where does it arise from?

adenocarcinoma of renal cortex which arises from the proximal convoluted tubule

2

risk factors renal cell carcinoma

smoking
obesity
HTN
renal failure
dialysis
polycystic & horseshoe kidneys
VHL (autosomal dom cond)

3

clinical features renal cell carcinoma

classic triad: (HiLF)
haematuria
loin pain
a mass in the flank
other features: malaise, weight loss, fever

4

renal cell carcinoma metastases?

25% have metastases at presentation to bone, liver and lung

5

investigations renal cell carcinoma

USS to distinguish benign cyst from tumour
CT / MRI more sensitive
Percutaneous biopsy. Bone scan if Ca raised

6

Management localised renal cell carcinoma

radical nephrectomy = preferred rx
partial nephrectomy if bilateral involvement or contralat kidney functions partly

7

what can be used for pts who wouldnt tolerate surgery

ablative techniques eg cryoablation or radiofrequency

8

Management metastatic/locally advanced renal cell carcinoma

interleukin-2 and interferon produce remission in 20% of cases

9

prognosis renal cell carcinoma

5 yr survival 60-70% with tumours confined to renal parenchyma but less than 5% in those with distant metastases

10

urothelial tumours affect what?

the calyces, renal pelvis, ureter, bladder and urethra are lines by transitional cell epithelium.
Bladder tumours are most common

11

epidemiology bladder transitional cell (urothelial) tumours

after 40y
4x more common in males

12

risk factors bladder cancer

cigarette smoking
exposure to industrial chemicals eg ß-naphthylamine, benzidine
exposure to drugs eg cyclophosphamide
chronic inflammation eg schistomiasis
FHx

13

what is schistomiasis

a parasite that causes chronic inflammation of the urinary tract = squamous cell carcinoma of the bladder
causes 50% of bladder cancers WW

14

clinical features bladder urothelial transitional cell carcinoma

painless haematuria
symptoms suggestive of a UTI (frequency, urgency, dysuria) in the absence of bacteriuria
pain is usually due to metastatic disease

15

transitional cell cancers of the kidney and ureters present with...

haematuria and flank pain

16

investigations urothelial tumours

haematuria of any pt over 40y should be assumed to have a urothelial tumour until proven otherwise
dipstick
bloods
flexible cytoscopy
upper tract imaging - CT/USS

17

management urothelial tumours

pelvic and ureteric tumours treated with nephroureterectomy
treatment bladder cancer depends on the stage - local diathermy or cystoscopic resection, TURBT, bladder resection, radiotherapy and local / systemic chemo

18

What is TURBT?

Transurethral resection of a bladder tumour
first line surgical rx for bladder tumours, like the cystoscope, the instrument used to remove the tumour is put in the bladder via the urethra - stage and grade

19

prostatic carcinoma - type of cancer?

adenocarcinoma

20

epidemiology prostatic carcinoma

common
malignant change within prostate is inc common with inc age - present in 80% of men age 80 and over - most cases remain dormant

21

clinical features prostatic carcinoma

screening for prostate cancer - serum PSA
bladder outflow obstruction
occasionally = symps of metastases to bone and nodes

22

diagnosis prostatic carcinoma

transrectal US of the prostate
elevated serum PSA
transrectal prostate biopsy
endorectal coil MRI to stage tumour

23

PSA

prostate specific antigen (NOT cancer specific)
elevated in benign prostate enlargement, UTI, prostatitis
70% with inc PSA will not have prostate cancer
6% with prostate cancer will not have inc PSA

24

management prostatic carcinoma

microscopic tumour - watchful waiting
if confined to gland - radical prostatectomy or radiotherapy = 80-90% 5y survival
need to remove adrogenic drive to the tumour - orchidectomy & synthetic luteinizing hormone

25

what is an orchidectomy

removal of the testosterone producing part of the testes

26

what do hormone therapies do in prostatic carcinoma

prevent release of testosterone = prevent tumour stimulation 80% are androgen sensitive

27

screening prostate cancer

controversial
annual measurement of serum PSA and digital rectal exam reduces mortality but benefit is small and potential for overdiagnosis and over treatment related to complications

28

testicular tumour epidemiology

most common cancer in young men

29

testicular tumour arise from

germ cells
2 main types: seminomas & teratomas

30

clinical features testicular tumour

typically man will find lump in testicle
presentation may be with metastases in the lungs = cough & dyspnoea or para-aortic lymph nodes, causing back pain

31

Investigations testicular tumour

USS to identify mass
serum conc of tumour markers a-fetoprotein (AFP) are elevated in teratomas
The ß subunit of human chorionic gonadotrophin (ß-hCG) are elevated in teratomas and seminomas
used for diagnosis and response to rx

32

rx testicular tumour

orchidectomy
seminomas w metastases below diaphragm =radiotherapy
more widespread = chemo
sperm banking should be offered prior rx

33

3 ways of metastatic spread

lymphatic
haematogenous
transcleromic

34

paraneoplastic syndromes
endocrine:
neurological:
dermatological:
haematological:

endocrine: cushings disease
neurological: dementia, cerebellar degeneration, peripheral neuropathy
dermatological: acanthosis nigricans
haematological: erythrocytosis