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Year 2 Urinary (JK) > Tumours of the urinary system 1 - prostate and testicular > Flashcards

Tumours of the urinary system 1 - prostate and testicular Flashcards

(57 cards)

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1
Q

What age is prostate cancer most common?

A

over 65

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2
Q

Describe the epidemiology of prostate cancer

A

most common cancer diagnosis in men

2nd most common cause of death in men - cancer

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3
Q

Risk factors for prostate cancer

A 
age 
race/ethnicity - African living in western countries 
family history 
food - probable 
drugs - 5 alpha reductase inhibitors
geography
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4
Q

What do 5 alpha reductase inhibitors do to the prostate cancer risk?

A

relative reduced risk 25-30%

increase risk of high grade tumours

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5
Q

Where do each of these develop in the prostate zones?
1 - BPH
2 - prostate cancer

A

1 - transitional

2 - peripheral

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6
Q

What cell type is prostate cancer?

A

adenocarcinoma

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7
Q

How are most prostate cancers picked up?

A

opportunistic PSA testing

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8
Q

Diagnostic triad of prostate cancer

A

PSA
digital rectal examination
TRUS guided biopsy

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9
Q

Is PSA specific?

A

prostate specific but not cancer specific

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10
Q

Localised prostate cancer symptoms (? more to do with BPH)

A

weak stream, hesitancy, sensation of incomplete emptying, frequency, urgency, urge incontinence, urinary tract infection

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11
Q

Locally invasive disease symptoms

A 
haematuria 
perineal and suprapubic pain 
impotence 
incontinence 
loin pain or anuria due to ureter obstruction 
symptoms of renal failure
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12
Q

Distant mets symptoms

A

bone pain or sciatica
lymph node enlargement
paraplegia - spinal cord compression

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13
Q

Widespread mets symptoms

A

lethargy - anaemia, uraemia

weight loss and cachexia

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14
Q

Why is prostate cancer not screened for?

A

Wilson-junger criteria not met
does not improve survival
leads to over diagnosis & treatment

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15
Q

Basis of PSA

A

kallikrein serine protease helps liquify semen and produced by prostate - may leak into serum

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16
Q

Threshold for PSA is dependent on?

A

age

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17
Q

7 reasons for increased PSA levels

A 
BPH 
prostate cancer 
chronic prostatitis 
instrument eg catheter 
urological procedure 
physiological eg ejaculation 
UTI
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18
Q

Half life of PSA

A

2.2 days

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19
Q

If repeat PSA needed when would it be done?

A

3 weeks eg 8 half lives later

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20
Q

What is meant by grading of cancer?

A

how aggressive it is histologically

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21
Q

Levels of grading in prostate cancer

A

3 to 5

3 well differentiated and 5 poor

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22
Q

How is the grading of prostate cancer done?

A

gleason SUM score

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23
Q

Describe the gleason sum score

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A

score of the 2 main histological grades with the 1st one being more common

24
Q

Why is the gleason sum score useful?

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A

prognosis and treatment

25
Describe the IPUS score in terms of gleason sum score
``` 1 - 3+3 2 - 3+4 3 - 4+3 4 - 8 5 - 9 &10 ```
26
How many stages of prostate cancer is there?
4
27
What are the 4 stages of prostate cancer?
localised locally advanced mets stage hormone refractory stage
28
5 ways to stage localised prostate cancer
``` CT MRI PSA digital rectal examination TRUS guided biopsy ```
29
3 treatments for localised prostate cancer and 2 other under investigation
watchful waiting radiotherapy - external beam, brachytherapy radical prostatectomy - open, laparascopic or endoscopic 1 - cryotherapy 2 - thermotherapy
30
5 treatment regimes of locally advanced prostate cancer
``` watchful waiting hormone therapy followed by surgery hormone therapy followed by radiation hormone therapy alone intermittent hormone therapy ```
31
4 types of hormone therapy
surgical castration eg bilateral orchidectomy chemical castration anti-androgens oestrogens
32
other organ complications of mets and hormone refractory prostate cancer
bones - pain, fractures, anaemia, spinal cord compression rectal - constipation, bowel obstruction ureteric - obstruction resulting in renal failure Pelvic lymphatic obstruction - lymphoedema, DVT LUT dysfunction - haematuria, acute retention
33
Supportive treatment in prostate cancer
palliative radiotherapy, colostomy etc
34
How do most testicular cancers present?
painless lump
35
Less often ways testicular cancer presents
tender inflamed swelling history of trauma - notice lump nodal or distant mets symptoms
36
who is testicular cancer common in?
young men (30's), caucasian
37
Risk factors for testicular cancer
testicular madescent infertility contralateral testicular cancer FH
38
Precursor lesion of testicular cancer
Testicular germ cell neoplasia in situ
39
Blood for tumour markers are taken when?
immediately before and serially after surgery
40
3 tumours markers for testicular cancer
AFP BHCG LDH
41
What testicular cancers are AFP and BHCG used for?
AFP - Teratoma | BHCG - seminoma
42
3 differential diagnoses for lump in testis apart from cancer
infection epididymal cyst missed testicular torsion
43
3 investigations of painless lump in testis
MSSU testicular ultrasound scan and CXR tumour markers
44
Treatment for testicular cancer
radical orchidectomy is essential
45
When would a biopsy of contralateral testis be needed?
high risk for tumour
46
What does further treatment after radical orchidectomy depend on?
tumour type, stage (TNM) and grade
47
What lymph nodes does testicular cancer spread to?
para aortic lymph nodes
48
Where is the incision made in a radical orchidectomy and why?
inguinal region | prevent obstructing lymphatics
49
Histological cell type of testicular cancer
germ cell tumour
50
2 types of germ cell tumour
seminomatous | non seminomatous
51
Main non seminomatous testicular cancer
teratoma
52
How is local staging of testicular cancer done?
pathological assessment of orchidectomy
53
Method of nodal and distant testicular cancer staging
CT
54
4 stages of testicular cancer
1: confined to testis 2: infradiaphragmatic nodes 3: supradiaphragmatic nodes 4: extra lymphatic disease
55
Low stage, -ve markers further treatment of testicular cancer
surveillance adjuvant radiotherapy prophylactic chemo
56
nodal disease/persistent tumour markers/relapse further treatment of testicular cancer
combination chemo | LN dissection
57
Prognosis of testicular cancer
stage 1 : 99% 5YS stage 2/3: 96% 5YS stage 4: 73% 5YS

Year 2 Urinary (JK) (26 decks)

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