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Renal / Urology > Tumours of the Urinary System > Flashcards

Tumours of the Urinary System Flashcards

(68 cards)

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1
Q

What can urothelial / transition cell cancer affect

A

Bladder (90%)
Ureter
Renal pelvic
Collecting system

ALL TCC

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2
Q

What is the most common bladder cancer

A

Transitional cell carcinoma

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3
Q

What is associated with TCC

A 
Age 
Smoking 
Aromatic amines - hair dye / industrial paint - ask occupational hx 
Cyclophosphamide 
Genetics - p53 + Rb
Chron's 
Renal transplant
Obesity
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4
Q

What other cancers can affect the bladder

A

SCC

Adeno <1%

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5
Q

What is associated with SCC

A 
Schistosomiasis 
Staghorn calculi 
Smoking 
Chronic cystitis from UTI / stone / catheter 
Pelvic RT
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6
Q

A person with vasculitis + haematuria

A

Investigate for bladder TCC as likely treat with cyclophosphamide

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7
Q

What is the grade of bladder cancer

A

Grade 1 = well differentiated, non-invasive
Grade 2 = moderate, non invasive
Grade 3 = poorly differentiated, invasive

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8
Q

What is CIS

A

Non invasive

Aggressive so high risk

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9
Q

What is Tis, T1

A

Non-invasive

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10
Q

What is T2 and >

A

Invades detrusor muscle

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11
Q

What are the symptoms of bladder TCC

A 
Painless visible haematuria = most common 
Weight loss
Recurrent UTI
Bladder pain
Voiding irritability 
Storage Sx if tumour big enough 
- Dysuria
- Frequency
- Nocturia 
Urge incontinence
May present as obstruction in acute urinary retention
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12
Q

Where does bladder cancer spread too

A

Local to pelvic
Para aortic and iliac nodes
Blood to liver and lungs
Bone = pain and hypercalcaemia

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13
Q

What can a bladder mass do

A

Obstruct ureter
Hydronephrosis
Nephrotic syndrome / renal failure

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14
Q

What do you do for unexplained non visible haematuria + no other sx

A

Refer <2 weeks for rigid cystourethroscopy + biopsy if frank and 4 weeks if microscopic

If
>50
RF
FH

Can do urine cytology as non-invasive test and will show malignant cells = 1st line

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15
Q

What other investigations for haematuria

A

Dipstick + MSSU to exclude infection
Bloods incl U+E
Urine cytology
Renal USS

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16
Q

How do you Dx and grade bladder cancer

A

TURBT - cystoscopy and resect including detrusor
EUA - biopsy
Flurosecent cystoscopy
Urine cytology can be useful in high grade as non-invasive and shows malignant cells

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17
Q

How do you stage

A

CTU to stage
MRI - pelvic node
Bone scan

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18
Q

How do you treat low grade non invasive

A

TURBT
Intravesicle chemo into bladder
Regular BCG vaccine into bladder
Most are this as people present with haematuria

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19
Q

How do you follow up

A

High risk of recurrence
Regular cystoscopy every 3 months for 2 years
Intense follow up

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20
Q

How do you treat high grade non invasive

A

50-80% will become invasive
Immunotherapy
Radical surgery - cystectomy with ideal conduit
Neoadjuvant chemo

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21
Q

How can high grade present

A

May appear like infection with no mass

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22
Q

How do you treat muscle invasive

A 
Radical cystectomy = gold standard
Chemotherapy - Neo and adjuvant
Radical RT
Cystoprostatectomy in men 
Anterior pelvic exenteration + urethrectomy in women
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23
Q

How do you treat T4

A

Palliative chemo / RT

Long term catheter

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24
Q

What are complications of cystectomy

A

Sexual and urinary malfunction
Bladder haemorrhage - disease or surgery
Increased risk of adenocarcinoma due to bowel being used in reconstruction

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25
What can you do for advanced disease with intractable haematuria
Alum solution bladder irrigation If no renal failure But intractable haematuria
26
Where else can TCC affect
Renal pelvis = common | Ureter
27
How does Upper tract TCC present
Frank haematuria Unilateral ureteric obstruction Flank or loin pain Met symptoms
28
What are symptoms of mets
Bone pain Hypercalcaemia Lung Brain
29
How do you investigate upper tract TCC
``` Haematruia investigation CTU Urine cytology Ureteroscopy + biopsy = diagnostic CT / MRI to stage ```
30
How do you treat
NEPHROURETERECTOMY
31
What do you do if unfitt for surgery
Ureterscopic laser ablation Surveillance Endoscopic if univocal and low grad
32
What is the risk of upper tract TCC
High risk of bladder TCC | 40% over 10 years
33
What type of cancer is renal cell carcinoma
Adenocarcinoma 15% TCC Wilms in children
34
What are benign cancer
Oncocytoma | Angiomyolipoma - associated TS
35
What are adenocarcinoma
``` Clear cell = 85% Papillary Hydronephroma Grawitz Wilm's in children ```
36
What is the classic triad of renal cell carcinoma
Flank pain Abdo mass Haematuria
37
What are parneoplastic symptoms
``` PUO Anorexia Malaise Weight loss Hypertension Hypercalcaemia Polycythaemia L varicocele Hepatic dysfunction - LFT / cholestasis Renal vein thrombosis ```
38
What causes hypertension
Renin secretion
39
What causes hypercalcaemia
PTH secretion
40
What causes polycythaemia
Erythropoeitin secretion
41
What causes L varicocele
Renal vein compressing testicular Testicular drains into renal so if renal blocks then varicocele forms Do renal USS if patient presents
42
Metastatic spread of renal cell carcinoma (25% at presentation)
``` Direct into posts / bowel / renal vein / adrenal Haematogenous Lymphatic - para-caval Lungs - cannon ball met = haemoptysis Bone Brain Liver ```
43
What are investigations for RCC
``` Haematuria Bloods- FBC, U+E, ALP Bone profile for mets Urine cytology Renal tract USS CXR for lung ```
44
What is diagnostic
CT scan CAP and KUB | Look for vascular invasion
45
When would you do bone scan
If symptoms
46
When would you do biopsy
If ablation planned
47
Why ALP
Bone mets
48
What are other options
USS CTU DMSA / MAG-3 for function
49
What should you always do
Assess contralateral kidney and testis
50
How do you treat
Radical nephrectomy Curative if +- RT / chemo
51
What do you do if unfit
Cyrotherapy Radiofrequency ablation Watch and wait
52
What predicts survival
Mayo Prognostic Risk Score
53
How do you treat mets / advanced disease
``` Immunotherapy as chemo and RT resistant - interleukin / interferon Tyrosine kinase inhibtor Targeted therapy against VEGF Surgery = not an option Palliative = only option ```
54
How does renal vein thrombosis present
Haematuria Loin pain High creatinine and Hb
55
What is T1
<7cm and confined
56
What is T2
>7cm and confined
57
What is T3
Local extension outside capsule - invades renal vein / IVC / LN
58
What is T4
Invades beyond Great fascia
59
What is common renal malignancy in children
Nephroblastoma
60
How does it present
Mass Haematuria Early lung mets
61
What are RF for Renal cell cancer
``` Age Male FH Smoking DM Obesity Hypertension ESRF / dialysis Polycystic kidney Tuberous sclerosis VHL ```
62
What suggests poor prognosis in renal cancer
Poor performance status Hb 1.5x Calcium high Presence of liver / lung / retroperitoneal LN
63
Anatomy kidney
``` Retroperitoneal T12-L3 L higher than R Renal artery of AA - L1/2 Renal vein to IVC Para-aortic node ```
64
Why do hydroceles occur on the L
L renal vein has to stretch over as IVC on the R side
65
Anatomy of ureter
``` Comes out renal pelvic ( Travels on anterior surface of psoas Transitional epithelium Crosses pelvic brim at sacroiliac joint to enter pelvic (PUJ) Enters blader at VUJ ```
66
What is water under bridge
Ureter (water) i posterior to uterine artery (bridge) in F and vas deferens in M IMPORTANT FOR SURGERY Don't want to clip
67
Anatomy of bladder
Continuaion of TCC
68
vHL
AD RCC Phaeochromocytoma Haemangioblastoma

Renal / Urology (16 decks)

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