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Flashcards in Tumours Of The Urinary Tract Deck (39):
1

What are the risk factors for prostate cancer?

Age
- risk increases with age
Hormones
Racial factors
- black
Familial and genetic factors
- abnormalities on chromosomes 1 and 8
- BRCA2 gene mutations
- PTEN and TP53 - tumour suppressor genes
Geographic variations
- highest in western cultures

2

What are the signs and symptoms of prostate cancer?

Asymptomatic
Painful/slow micturition
UTI
Haematuria
Urinary retention
Lymphoedema
Metastatic
- bone pain
- renal failure (ureteric obstruction)

3

What investigations are used in the diagnosis of prostate cancer?

Digital rectal examination
PSA - prostate specific antigen
TRUS - needle guided biopsy

4

Where in the prostate do prostate cancers normally arise?

Peripheral zones

5

What is the Gleason grading system?

Based on the extent to which the tumour cells are arranged into recognisable glandular structures and describes and spectrum of histological malignancies
<4 - well differentiated
5-7 - moderately differentiated
>7 - poorly differentiated

6

Describe the T staging (in TNM staging) of the prostate.

T1 - tumour can't be seen with imaging or felt on DRE (incidental finding by transrectal US)
T2 - can be felt by DRE or seen on TRUS, but confined to the prostate
T3 - cancer has grown outside the prostate, possibly into the seminal vesicles

7

Describe the N staging (in TNM staging) of the prostate.

N0 - not spread to any nearby lymph nodes
N1 - cancer has spread to one or more nearby lymph ndoes

8

Describe the M staging (in TNM staging) of the prostate.

M0 - cancer hasn't spread beyond nearby lymph nodes
M1 - cancer has spread beyond nearby lymph nodes

9

How does the prostate specific antigen help assess the prostate?

Serine protease is secreted into seminal fluid
- responsible for the liquefaction of seminal coagulation Small proportional leaks into circulation
Tissue, not tumour specific

10

What is the normal level of PSA?

50-59 >3ng/ml
60-69 >4ng/ml
70-79 >5 ng/ml

11

What is the treatment for localised prostate cancer?

Waiting
Radiotherapy
- external beam
- conformal
- brachytherapy
Radical prostatectomy
Cryotherapy
TURP if symptomatic

12

What are the metastatic complications of prostate cancer, and how are they treated?

Spinal cord compression
- severe pain
- retention
- urgent MRI
- radiotherapy vs spinal decompression surgery
Ureteric obstruction
- anorexia, weight loss, raised creatinine
- nephrostomise or stenting

13

What are the treatment options for advanced prostate cancer?

Androgen ablation therapy
- medical castration (LHRH analogue)
Surgical castration
TURP for symptom relief
Chemotherapy
Radiotherapy

14

What are the risk factors for bladder cancer?

Age
- common in 80s
Race
- white
Environmental carcinogens
Chronic inflammation
- stones, infection, long term catheters
Drugs
- phenacitin
- cyclophsophamide
Pelvic radiotherapy
Smoking

15

How does bladder cancer present?

Painless frank haematuria
Microscopic haematuria (5% of cases)

16

How is bladder cancer diagnosed?

Cystoscopy
Renal USS/KUB

17

Which types of bladder cancer are the most common?

Transitional cell carcinoma (90%)
- superficial 75%
- invasive - 25%
Squamous carcinoma (5%)
Adenocarcinoma (2%)
Metastatic

18

What is the grading system for bladder cancer?

Grade 1 - well differentiated
Grade 2 - moderately differentiated
Grade 3 - poorly differentiated
Carcinoma in situ

19

Describe the tumour staging for bladder cancer.

Tis - carcinoma in situ
Ta - noninvasive papillary carcinoma
T1 - invasion of the lamina propria
T2 - invasion of the muscle layer of the bladder wall
T3 - tumour has spread into the perivesical tissue (fatty tissue surrounding the bladder)
T4 - tumours has spread to the (a) abdominal wall, pelvic wall or (b) prostate/seminal vesicles or uterus/vagina

20

What is the treatment for bladder cancer?

Urgent trans-urethral resection of bladder tumour
CT IVU
Bimanual examination carrier out
Intravesicle mitomycin reduces risk of recurrence

21

How is a low grade superficial (non-invasive papillary tumour) treated?

Low risk of progression
- flexible check cystoscopy every 3 months
6 weekly course of mitomycin treatments for persistent tumours

22

How is a high grade, non-muscle invasive bladder cancer treated?

50% chance of progression to muscle invasive disease
Cystoscopy and re-biopsy
Treat with intravesical BCG immunotherapy
- 6 weeks
- then further cystosopy and biopsy
Cystectomy if treatment fails

23

How is muscle invasive bladder cancer treated?

Requires radical therapy
- cystectomy or radiotherapy
Radiotheapy doesn't work well if there is multifocal disease or widespread CIS
Neo-adjuvant chemotherapy

24

How is metastatic bladder cancer treated?

Often pulmonary
Treated with chemotherapy
- M-VAC
- methotrexate, vinblastine, doxorubicin and cisplatin
- highly toxic
Gemicitobine and docetaxel

25

What are the different types of renal tumour?

Renal cell carcinoma (85%)
Transitional cell carcinoma
Sarcoma
Metastases

26

What are the risk factors for renal cell carcinoma?

Smoking
Obesity
Hypertension
Acquired renal cystic disease
Haemodialysis
Genetics
- VHL, HPRCC, tuberous sclerosis

27

How do renal carcinomas present?

80% incidental
25% systemic symptoms
- night sweats
- fever
- fatigue
- weight loss
- haemoptysis
10% classic triad
- mass, pain and haematuria
Varicocele
Lower limb oedema
Paraneoplastic syndrome

28

Name the paraneoplastic syndomes.

Polycythaemia (from increased EPO)
Hypercalcaemia (PTH like substance)
Hypertension (renin secretion)
Deranged LFTs
ACTH, prolactin, insulin and gonadotrophins ( all rare)

29

How is the initial diagnosis of renal cell carcinoma made?

US
FBC, UEs, LFTs, CRP, bone profile and LDH
CT kidneys
MRI
Renal biopsy
CT chest - mets

30

Describe the tumours staging of renal cell carcinomas.

T1 - <7cm
T2 - >7cm
T3 - enters the renal vein/IVC
T4 - extends beyond the Gerota fascia

31

How is a large renal mass treated?

Radical nephrectomy
- removal of kidney and Gerota's fascia (sparing the adrenal gland)

32

How are small renal masses treated?

Biopsy
Nephron sparing surgery (partial neprectomy or cryotherapy)
- when it affects a single kidney
- CKD
- CV risk factors
- T1a tumours
Radical nephrectomy
Surveillance

33

How are metastatic renal cell carincomas treated?

Tyrosine Kinase Inhibitor

34

What are the risk factors for testicular cancer?

Age 20-45
Cryptorchidism
HIV
Caucasian

35

How does testicular cancer present?

Painless lump
Often found after incidental trauma

36

What are the investigations for testicular cancer?

Scrotal US
Tumour markers
- alpha feroprotein
- beta hCG
- LDH

37

What are the different classifications of testicular cancers?

Germ cell
- seminoma
- teratoma
- mixed
- yolk sac
Stromal tumours
- leydig
- sertoli
Other
- lymphoma
- metastasis

38

What is the treatment for testicular cancer?

Radical orchidectomy
Chemotherapy
Para-aortic nodal radiotherapy
Retroperitoneal lymph node dissection

39

What is the treatment for penile cancer?

Circumcision
Topical treatment CO2/5FU
Penectomy and reconstruction
Lymphadenectomy
Chemo/radiotherapy