Tumours of the Urinary System Flashcards by Lucy Jefford

What is the most common cancer diagnosed in med?

Prostate cancer

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In blood tests, what is looked at specifically regarding prostate cancer?

PSA
-> prostate specific antigen

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Generally, what is the prognosis of prostate cancer like?

Very good

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What are some of the risk factors for prostate cancer?

Increasing age
Family history
Race/ethnicity
Georgaphy
Obesity
Diet

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Which race/ethnicity is most at risk of prostate cancer?

African/Afro-Caribbean have highest risk
Caucasian have moderate risk
East Asian have lowest risk

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Family history of which syndrome increases risks of prostate cancer?

Lynch syndrome

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What % of prostate cancers can be palpated via the rectum?

80%

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Which zone of the prostate do most prostate cancers occur?

Peripheral zone

P=P

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RECAP- name the four zones of the prostate

Transition zone
Central zone
Peripheral zone
Anterior fibromuscular stroma

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What is important to note about the symptoms of prostate cancers?

Often asymptomatic and do not present with usual cancer symptoms e.g. weight loss

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How is prostate cancer diagnosed?

Opportunistic ad hoc PSA testing

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What is important to note about PSA elevation?

Whilst PSA is prostate specific, it is not cancer specific, so when raised, it’s not always cancer

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When else may PSA be raised apart from prostate cancer?

BPE (benign prostate enlargement)
Infection

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What are the symptoms of localised prostate cancer?

Trick question, if it’s localised, there will be no symptoms

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What are some of the symptoms of distant metastases from metastatic prostate cancer?

Bone pain or sciatica
Paraplegia secondary to spinal cord compression
Lymph node enlargement
Loin pain or anuria due to obstruction of ureters by lymph nodes

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What are some of the symptoms of widespread metastases from metastatic prostate cancer?

Lethargy
Weight loss

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What is the commonest mode of presentation for prostate cancer?

Asymptomatic - incidentally noted

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What is important to note about normal serum range for PSA?

It increases with age because of BPH

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What is the normal PSA for those who are <50?

2.5 upper limit

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What is the normal PSA for those who are 50-60?

3.5 upper limit

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What is the normal PSA for those who are 60-70?

4.5 upper limit

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What is the normal PSA for those who are >70?

6.5 upper limit

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What can be done to differentiate between transient and persistent rise in PSA?

Recheck PSA in at least 3 weeks

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How long is the half-life of PSA?

2.2 days

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List some causes of transient causes of elevated PSA.

UTI Chronic prostatitis Instrumental e.g. catheterisation Physiological e.g. ejaculation Recent urological procedure

List some causes of persistent causes of elevated PSA.

BPH Prostate cancer

Okay, so, if a GP checks bloods of a man and the PSA is elevated, what should they do?

Not worry and recheck in 3 weeks If still raised, it's a persistent rise

How is a diagnosis of prostate cancer most commonly made?

Usually due to a rise in age-specific PSA Abnormal prostate on digital rectal examination

If prostate cancer is suspected, what is done to confirm?

Pre-biopsy prostate multiparametric MRI to identify the area of interest to biopsy Biopsy then carried out ->important to note that MRI does not actually diagnosis but gives information relating to diagnosis. Can also be used for staging of prostate cancer

Basically just give a wee summary pf the steps of a prostate cancer diagnosis pls x

Serum PSA Digital rectal examination Pre-biopsy MRI Biopsy Additional staging for metastasis if required e.g. bone scan

What is meant by ad hoc PSA testing?

Testing PSA level in men who are worried about prostate cancer or who have family history, not testing every man once he reaches a certain age like breast screening

What is meant by the grading of cancer?

Assessment of the aggression of the cancer

What is meant by staging of cancer?

Assessment of the spread of cancer

What is grading of prostate cancer based on?

Gleason sum score

What is used for the staging of cancer?

TMN staging system

How is a Gleason Sum Score given?

Score of 3-5 given looking at the largest area Score of 3-5 given looking at the second largest area Two numbers added to give the total sum score

What is the commonest organ that prostate cancer spreads to?

Bone

For the purposes of treatment and prognosis, prostate cancer is divided into 4 clinical stages. What are they?

Localised stage Locally advanced stage Metastatic stage Castrate-resistant/Hormone-refractory stage

What is the treatment for localised prostate cancer?

Watchful waiting Radiotherapy Radical prostatectomy

What is the treatment for locally advanced prostate cancer?

Watchful waiting Hormone therapy followed by surgery Hormone therapy followed by radiation

What does prostate cancer require to fuel it's growth?

Testosterone

The following are reasonable treatment options for low-risk localised prostate cancer EXCEPT: a. external beam radiotherapy b. active surveillance c. brachytherapy d. radical prostatectomy e. radical chemotherapy

E- radical chemotherapy ->this is for advanced disease

What is the presentation of testicular cancer?

Usually a painless lump Can be tender, inflamed, swollen

What decade is the peak incidence of testicular cancer?

3rd decade (20-30)

What are some of the risk factors for testicular cancer?

Undescended testis-- 10 x risk Infertility Genetic abnormalities Chromosomal abnormalities Race- Caucasian

Which syndrome increases risks of testicular cancer?

Klinefelter syndrome

If there is a lump in the testis, it is considered to be a testicular tumour until proven otherwise. What are some differential diagnosis'?

Infection Epidydimal cyst Missed testicular torsion

What tests should be considered for someone with a lump in the testis?

MSSU STI screen Tumour markers

What is the most important imaging investigation in the diagnosis of testicular cancer?

Testicular ultrasound

What are the three main tumour markers indicative of testicular cancer?

AFP HCG LDH -> in 70% of testicular cancers, at least one will be abnormal

For testicular cancer, the main lymphatic spread to regional lymph nodes occurs in which group of lymph nodes?

Para-aortic lymph nodes

What is the treatment for testicular cancer?

Radical orchidectomy using an inguinal incision

Why is biopsy of testicular mass not carried out?

Risk of tumour seedling across biopsy tract

What type of tumour makes up 95% of testicular cancers?

Germ cell tumour ->other 5% are non-germ cell tumours

What are the three ways testicular cancer can spread?

Local spread e.g. local invasion Regional spread to para-aortic lymph nodes Distant spread e.g. lungs, bone, liver

Stage 1 testicular cancer?

Disease confined to testes

Stage 2 testicular cancer?

Infra-diaphragmatic para-aortic lymph nodes involved

Stage 3 testicular cancer?

Supra-diaphragmatic para-aortic lymph nodes involved

Stage 4 testicular cancer?

Extra-lymphatic disease involving solid organs e.g. lungs, liver and bone

What is the treatment for metastatic testicular cancer?

Chemotherapy

What are urothelial tumours?

Malignant tumours of the lining transitional cell epithelium which can occur at any point in the urinary tract

Where is the most common site for urothelial tumours?

Bladder-90%

What is the usual tumour type of bladder cancer?

Transitional cell carcinoma

In countries where schistosomiasis is endemic, e.g. Sub-Saharan Africam what is the most common tumour of the bladder?

Squamous cell carcinoma

What are some risk factors for transitional cell carcinoma?

Smoking Aromatic amines Non-hereditary genetic abnormalities

What are some of the risks factors for squamous cell carcinoma?

Schistosomiasis Chronic cystitis Cyclophosphamide therapy Pelvic radiotherapy

What is the most common presenting feature of bladder cancer?

Painless visible haematuria

What are some other presenting features of bladder cancer?

Recurrent UTI's Storage bladder symptoms e.g. dysuria, frequency, urgency, incontinence Bladder pain

What is the first step if a patient presents with haematuria?

Urine culture to rule out infection

What other investigations are used to investigate haematuria?

Upper tract imaging e.g. ultrasound for kidneys, CT urogram for ureters Urine cytology BP, U&E's

Above what age is frank haematuria suggestive of nalignancy?

>50

If someone above 50 has frank haematuria, what should be done?

Flexible cystourethroscopy within two weeks IVU and ultrasound

In a patient over 50 with microscopic haematuria, what should be done next?

Flexible cystourethroscopy within 4-6wks Ultrasound

What is meant by carcinoma is situ?

Cells at the base of the membrane have changed their appearance but are not truly invading yet

If a bladder cancer was given the stage Ta, what does this mean?

Cancer is superficial and does not invade the lamina propria

If a bladder cancer was given the stage T1, what does this mean?

Cancer is through the lamina propria but not invading the detrusor muscle

If a bladder cancer was given the stage T2, what does this mean?

Cancer going into detrusor muscle

If a bladder cancer was given the stage T3, what does this mean?

Cancer spreading more though detrusor muscle

If a bladder cancer was given the stage T4, what does this mean?

Bladder cancer is spreading to other organs

What is the treatment for bladder cancer if it is low grade and non-muscle invasive?

Endoscopic resection followed by single instillation of chemotherapy

What is the treatment for bladder cancer if it is high grade and non-muscle invasive?

Intravesical BCG ->Endoscopic resection alone not sufficient BCG is same as vaccine for TB as allows bladder to fight it's own cancer

What is the treatment for muscle invasive bladder cancer?

Neoadjuvant chemotherapy followed by radical radiotherapy and/or radical cystoprostatectomy in men and hysterectomy in women

What is the prognosis like for: a. non-invasive low-grade bladder cancer b. invasive, high-grade bladder cancer

a. 90% 5yr survival b. 50% 5yr survival

What are the symptoms of upper tract urothelial cancers?

Frank haematuria Unilateral ureteric obstruction Flank or loin pain

What are the diagnostic investigations for upper tract urothelial cancers?

CT-IVU or IVU Urine cytology Ureteroscopy and biopsy

Where is the commonest site for upper tract urothelial cancers?

Renal pelvis or collecting system

Name two types of benign renal cancers.

Oncocytoma Angiomyolipoma

What is the most common malignant renal tumour

Renal carcinoma

Where do most renal adenocarcinomas arise from?

Proximal tubules

What are some of the risk factors for renal adenocarcinoma?

Family history Smoking Anti-hypertensive medication Obesity End-stage renal failure Acquired renal cystic disease

What is the presentation of renal adenocarcinoma?

50% asymptomatic 10% classic triad of flank pain, mass and haematuria

How can renal adenocarcinomas spread?

Direct invasion through the renal capsule Venous invasion to renal vein and vena cava

Where can hematogenous spread of renal adenocarcinoma spread to?

Lungs and bone most commonly

What investigations are used in renal adenocarcinomas?

CT scan of abdomen and chest mandatory Bloods; U&E's, FBC

What is the treatment of renal adenocarcinoma?

Surgery- radical nephrectomy

Tumours of the Urinary System Flashcards

(95 cards)