Tumours of the Urinary System 2 (Bladder and Renal Cancer) Flashcards
(31 cards)
Where can urothelial cancer occur? What is the most common site?
At any point along the transitional cell epithelium, from renal calyces to the tip of the urethra
- Most common site is bladder: 90% of cases
What is the most common type of bladder cancer?
- Transitional cell carcinoma (TCC)
- Where Schistosomiasis (infection from parasitic worm) is endemic, squamous cell carcinoma (SCC) of the bladder is most common type (Africa, South America, the Caribbean, the Middle East and Asia)
What are the risk factors for transitional cell carcinoma of the bladder?
- Smoking (accounts for 40%)
- Aromatic amines
- Genetics (TSG, p53, Rb)
What are the risk factors for squamous cell carcinoma of the bladder?
- Schistosomiasis (S. haematobium only)
- Chronic cystitis
- Cyclophosphamide therapy
- Pelvic radiotherapy
How does bladder cancer tend to present?
- Painless visible haematuria (frank or microscopic)
- Metastatic symptoms
- Recurrent UTI
- Storage symptoms: dysuria, frequency, urgency, incontinence
What is frank haematuria? What is microscopic haematuria?
- Frank: reported by patient
- Microscopic: detected by doctor / tests
What investigations should be performed on haematuria that suggests bladder cancer?
- Urine culture (rule out UTI)
- CT urogram / USS
- Cystourethroscopy (visualize the urethra & bladder)
- Urine cytology
What is the risk of malignancy with Frank haematuria? What are some investigations when the patient cites Frank haematuria?
- If >50yrs risk of malignancy is 25-35%
- Flexible cystourethroscopy within 2 weeks
- CT urogram and USS
What is the risk of malignancy with microscopic haematuria? What are some investigations when microscopic haematuria is seen?
If >50yrs risk of malignancy is 5-10%
- Flexible cystourethroscopy within 4-6 weeks
- USS
What investigations are used for staging of bladder cancer?
cross-sectional imaging (CT, MRI)
Bone scan if symptomatic
CT Urography for upper tract TCC
What is the main surgical treatment for bladder cancer?
TURBT
Trans-urethral resection of bladder tumour
What is the main test for diagnosis of bladder cancer? Why?
Cystoscopy / Fluourescent Cystoscopy
- A cystoscopy is a procedure to look inside the bladder using a thin camera called a cystoscope
- Why: permits biopsy and resection of papillary tumours
How are bladder tumours classified?
Graded & Staged (TNM staging) Grades: - G1 = Well diff. - commonly non-invasive - G2 = Mod. diff. - often non-invasive - G3 = Poorly diff. - often invasive
What are the usual treatment plans for low grade non-muscle invasive tumours (Ta & T1) and high grade non-muscle invasive tumours of the bladder?
- Low grade: endoscopic resection followed by single instillation of intravesical chemotherapy within 24 hours
- High grade: Endoscopic resection plus intravesical BCG therapy (maintenance course, weekly for 3 weeks repeated 6 monthly over 3 years)
What is the usual treatment plan for muscle invasive tumours of the bladder? (T2 & T3)
- Neoadjuvant chemotherapy
- radical cystoprostatectomy (men) or anterior pelvic exenteration with urethrectomy (women)
- Urinary Diversion (eg. ileal conduit / catheterizable stoma)
What is the prognosis for bladder cancer like?
Non-invasive, low grade bladder TCC: 90% 5-year survival
Invasive, high grade bladder TCC: 50% 5-year survival
Where do upper tract urothelial cancers tend to occur? What is the most common type?
- in the ureter, renal pelvis & collecting system
- TCC
What are the main signs / symptoms of upper tract urothelial cancer?
- Frank haematuria
- Unilateral ureteric obstruction
- Flank / loin pain
- Metastatic symptoms
What investigations should be done for suspected upper tract urothelial cancer? (UTUC)
CT-IVU or IVU (intravenous urogram)(show filling defect in renal pelvis)
Urine cytology
Ureteroscopy and biopsy
What treatment options are available for upper tract urothelial cancer?
- nephro-ureterectomy (minimally invasive surgical procedure to remove a patient’s renal pelvis, kidney, ureter, and bladder cuff)
- ureteroscopic laser ablation (need regular uteroscopic surveillance afterwards)
What are the two most common benign cancers of the kidneys?
- oncocytoma
- angiomyolipoma
What is the most common malignant cancer of the kidneys?
- Renal adenocarcinoma
Four histological subtypes: clear cell (85%)
papillary (10%)
chromophobe (4%)
Bellini type ductal carcinoma (1%)
What are some risk factors for renal adenocarcinoma?
- Family history (genetics)
- Smoking
- Anti-hypertensive medications
- Obesity
- End stage renal failure
- Acquired renal cystic disease
How do renal adenocarcinomas tend to present?
- Classic triad: flank pain, palpable mass, haematuria
- 50% asymptomatic
- Paraneoplastic syndromes: anorexia, pyrexia, cachexia (weakness / wasting), hypertension, hypercalcaemia
- Metastatic disease
