Flashcards in Urinary: Malignancy of the Urinary Tract Deck (23):
How common is prostate cancer?
The most commonly diagnosed cancer in men, however most will be asymptomatic, localised disease and will be unlikely to die of their prostate cancer.
What are the risk factors for prostate cancer?
Age - 80% of men over 80 have prostate cancer
Family history - 4x increased risk
Ethnicity - black>white>asian
What are some other causes of raised PSA (except cancer)?
Infection eg UTI
Prostatitis - inflammation
Enlarged prostate - more tissue to more PSA made
What are some symptoms of prostate cancer?
- frequency, urgency and nocturia
- feeling that bladder has not emptied fully
- bone pain (prostate cancer spreads to bones)
How is prostate cancer diagnosed?
Digital rectal examination - the cancer usually grows on the periphery so can be felt
What is the gleason score?
2 components - the grade of the worst area + the grade of the most common area
How is localised prostate cancer treated?
Most often just surveillance
Radical prostatectomy - however 1/3 will have erectile dysfunction and 1/3 will have urinary side effects
Radiotherapy, can but radioactive seeds of iodine in the prostate
How is metastatic prostate cancer treated?
Leutanizing hormone agonists which act on leydig cells in the testis to reduce the amount of testosterone produced (prostate cancer needs testosterone to grow)
Palliative radiotherapy, chemotherapy
What is unique about prostate metastasis to bone?
It is osteoblastic so builds bone whereas other cancers eg breast are osteoclastic
What is the chance of finding malignancy in visible and non visible heamaturia?
Visible haematuria: 20% chance of finding malignancy - very high
Symptomatic 5% chance of malignancy
Asymptomatic 0.5% chance of finding malignancy
What is the differential diagnosis for someone presenting with haematuria?
Cancer: renal cell carcinoma, upper tract transitional cell carcinoma, bladder cancer, advanced prostate carcinoma
Other: stones, infection, inflammation, benign prostate hyperplasia, glomerular pathology
What examinations and investigations would you do for a pt presenting with haematuria?
Examinations: blood pressure, abdo mass, digital rectal examination
Investigations: full blood count, urine culture, USS to look for kidney tumours and hydronephresis, flexible cystoscopy to look in bladder
What is the epidemiology of bladder cancer?
It is the 4th most common cancer in men and 11th in females
Incidence is decreasing due to decreased smoking
More common in men but presents more advanced in women
What are the risk factors for bladder cancer?
- smoking increases risk 4x
- occupational exposure eg painters, handling of carbon, crude oil, rubber or plastics
- schistosomiasis eg Egypt causes recurrent irritation so get squamous cell carcinoma
How do you treat bladder cancer?
Low risk non muscle invasive transitional cell carcinoma: may do intravesical chemotherapy
High risk non muscle invasive transitional cell carcinoma:
Muscle invasive transitional cell carcinoma:
Neoadjuvant chemo and radica cystectomy (removal of bladder) or radical radiotherapy
How common is renal cell carcinoma?
7th most common cancer in UK and responsible for 95% of upper urinary tract tumours
More common in males
What are the causes of renal cell carcinoma?
Smoking, obesity and dialysis
How can renal cell carcinoma spread?
Directly through peri-renal fat
Via the IVC to the right atrium
Via lymph nodes
How do you manage renal cell carcinoma that has not metastasised?
Surveillance, removal of a kidney, ablation
How do you manage metastatic renal cell carcinoma?
Palliative care - renal cell carcinomas respond poorly to chemo and radiotherapy so use molecular therapies targeting angiogenesis
How common are upper tract transitional cell carcinomas?
Rare - only % of upper tract malignancies
How would you investigate an upper tract transitional cell carcinoma?
USS to look for hydronephrosis
CT to look for filling defect or ureteric stricture