Tumours of Urinary System

Question 1

What are urothelial tumours?

Answer 1

Malignant tumours of transitional cell epithelium

Question 2

Where can urothelial tumours occur?

Answer 2

Anywhere along the renal tract

From renal calyces to tip of urethra

Question 3

Where is the most common site (90%) of urothelial tumours?

Answer 3

Bladder

Question 4

What is the commonest tumour of the bladder?

Answer 4

Transitional cell carcinoma

Question 5

What endemically can cause squamous cell carcinoma of the bladder?

Answer 5

Schistosomiasis

Question 6

What are the risk factors for TCC?

Answer 6

Smoking
Aromatic amines
non-hereditary genetic abrnormalities

Question 7

What are the risk factors for squamous cell carcinoma of bladder?

Answer 7

Schistosomiasis
Chronic cystitis
Cyclophosphamide
Pelvic radiotherapy

Question 8

Where are the vast majority of adenocarcinomas of the bladder found?

Answer 8

Urachal

Question 9

What are the common presenting features of bladder cancer?

Answer 9

Painless visible haematuria 
Symptoms due to metastatic disease 
Recurrent UTI 
Storage bladder symptoms 
e.g:
- dysuria 
-frequency
-nocturia

Question 10

What is the commonest cause of painful haematuria?

Answer 10

UTI

Question 11

What investigations should be done for suspected bladder cancer?

Answer 11

Urine culture 
Cystourethroscopy 
CT urogram 
USS 
Urine cytology 
BP 
U&E

Question 12

What is the risk of malignancy in frank haematuria?

Answer 12

High

Question 13

What is the next line investigation for frank haematuria>

Answer 13

Flexible cystoscopy within 2 weeks

IVU & USS

Question 14

What is the malignancy risk of dipstick microscopic haematuria?

Answer 14

Lower

Question 15

What is the next line investigation for microscopic haematuria?

Answer 15

Flexible cystoscopy within 4-6 weeks

IVU & USS

Question 16

How is diagnosis for bladder cancer made>

Answer 16

Cystocopy and endoscopic resection

EUA to asses bladder mass/thickening

Question 17

What staging is used for bladder cancer?

Answer 17

TNM

Question 18

How is bladder cancer staged?

Answer 18

CT

MRI

Question 19

What is the treatment for bladder cancer?

Answer 19

TURBT

Radical

Question 20

What is Grade 1 of bladder cancer?

Answer 20

Well differentiated

Commonly non-invasive

Question 21

What are features of grade 2 bladder cancer?

Answer 21

Moderately differentiated

Often non-invasive

Question 22

What are features of grade 3 bladder cancer?

Answer 22

Poorly differentiated

Often invasive

Question 23

What are the 2 descriptions of T stages in bladder cancer?

Answer 23

Non-muscle invasive

Muscle invasive

Question 24

Which muscle is invaded in bladder cancer?

Answer 24

Detrusor m.

Question 25

`What is the treatment for low grade non-muscle invasive bladder cancer?

Answer 25

TURBT Followed by single instillation intravesical chemo within 24 hrs Prolonged endoscopic follow up for moderate grade tumours - cystoscopy on regular basis

Question 26

What is the treatment for high grade non-muscle invasive bladder tumour?

Answer 26

Very aggressive | Endoscopic resection alone not sufficient

Question 27

What should CIS bladder tumour treatment be>

Answer 27

Intravesical BCG therapy | Weekly for 3 weeks repeated 6 monthly over 3 years

Question 28

What is the treatment for muscle invasive bladder cancer?

Answer 28

Neoadjuvant chemo for local and systemic control Radical radiotherapy and/or radical Cystoprostatectomy (men) or anterior pelvic exenteration with urethrectomy (women); with extended lymphadenectomy

Question 29

What is the prognosis of bladder cancer dependent on?

Answer 29

Stage Grade Size Multifocality

Question 30

What are the main symptoms of Upper tract urothelial cancer?

Answer 30

Frank haematuria Unilateral ureteric obstruction Flank or loin pain

Question 31

What are some symptoms of metastatic UTUC cancer?

Answer 31

Bone pain | Hypercalcaemia

Question 32

What investigations should be done for UTUC?

Answer 32

CT IVU Urine cytology Uteroscopy and biopsy

Question 33

Where is upper tract TCC more commonly found?

Answer 33

Renal pelvis | or collecting system

Question 34

Where is upper tract TCC less commonly found?

Answer 34

Ureters

Question 35

What is there a high risk of in endoscopic resection in upper tract TCC?

Answer 35

Local recurrence

Question 36

How are most upper tract TCC best treated?

Answer 36

By radical nephro-ureterectomy | RNU

Question 37

What is nephro-ureterectomy?

Answer 37

Minimally invasive surgical procedure to remove the renal pelvis, kidney and entire ureter, along with the bladder cuff

Question 38

Name 2 benign renal tumours?

Answer 38

Oncocytoma | Angiomyolipoma

Question 39

What is the commonest malignant renal tumour?

Answer 39

Renal adenocarcinoma

Question 40

Where do most renal adenocarcinomas arise from?

Answer 40

Proximal tubules

Question 41

What is the commonest histological subtypes of renal adenocarcinoma?

Answer 41

Clear cell

Question 42

What are the risk factors for Renal adenocarcinoma?

Answer 42

``` FH Smoking Anti-hypertensives Obesity End-stage renal disease ```

Question 43

What is the typical presentation of renal carcinoma?

Answer 43

Asymptomatic with incidental finding (50%) Classic triad 1. flank pain 2. mass 3. haematuria Paraneoplastic syndrome Metastatic disease e.g bone pain

Question 44

Where are common sites of metastases for renal cancer?

Answer 44

Bone Brain Lung Liver

Question 45

How is renal cancer staged?

Answer 45

CT

Question 46

What staging is used for renal cancer?

Answer 46

TNM

Question 47

What is TNM T1 for renal carcinoma?

Answer 47

<7cm | Confined within renal capsule

Question 48

What is TNM T2 for renal cancer?

Answer 48

Local extension outside capsule

Question 49

What is T3 TNM for renal cancer?

Answer 49

Local extension outside capsule | T3b and T3c involved vena cava

Question 50

Where can renal cancer have venous invasion to?

Answer 50

IVC

Question 51

What investigations are done for renal cancer?

Answer 51

CT | Blood; U&E, FBC

Question 52

What is the treatment for renal cancer?

Answer 52

Radical nephrectomy - laparoscopic or open Palliative cytoreductive nephrectomy in metastatic disease Immunotherapy