Uro - Urological Cancers Flashcards
(44 cards)
What are the different groups of urological cancers?
→ kidney
→ prostate
→ bladder
→ testicular + penile (much more rare)
What is the epidemiology of kidney cancers like?
→ 13,100 new kidney cancer cases in the UK every year(1)
→ Kidney cancer is the 7th most common cancer in the UK(1)
→ Incidence and mortality rising (2)
What are the different types of kidney cancers + their prevalence?
→ 85% = Renal Cell carcinoma (adenocarcinoma)
→ 10% = transitional cell carcinoma
→ 5% = Sarcoma/Wilms tumour/other types
What are the risk factors for kidney cancers?
→ genetic factors → smoking → obesity → patients on renal dialysis → hypertension
What are the usual clinical signs of kidney cancer?
→ Painless haematuria
→ persistent microscopic haematuria (red flag symptom and can reflect any of these urological malignancies)
→ Loin pain
→ Palpable mass
→ Metastatic disease symptoms –bone pain, haemoptysis
What are the investigations done for kidney cancer if there is painless visible haematuria?
→ flexible cystoscopy
→ CT urogram
→ renal function
What are the investigations done for kidney cancer if there is persistent non-visible haematuria?
→ Flexible cystoscopy
→ US KUB (ultrasound of the kidneys, ureters and bladder)
What are the investigations if kidney cancer is suspected?
→ CT renal triple phase
→ staging CT chest
→ bone scan if symptomatic
How do you stage RCC kidney cancers?
→ T1 – Tumour ≤ 7cm
→ T2 – Tumour >7cm
→ T3 – Extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia
→ T4 – Tumour beyond perinephric fascia into surrounding structures
→ N1 – Met in single regional lymph node
→ N2 – met in ≥2 regional lymph nodes
→ M1 - distant met
How do you grade kidney cancers via Fuhrman grades?
→ 1 = well differentiated
→ 2 = moderate differentiated
→ 3 + 4 = poorly differentiated
What does kidney cancer management depend on?
Patient specific, depends on:
→ the ASA status (ability to tolerate surgery and anaesthesia)
→ comorbidities
→ classification of lesion (TMN staging)
How is kidney cancer managed?
Gold standard is excision either via:
→ Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)
→ Radical Nephrectomy
How do you treat patients with very small tumours who are unfit for surgery?
cryosurgery
→ tumours are frozen which destroys cancer cells and abnormal tissue
How do you treat the metastatic disease of kidney cancers?
(RTKI) receptor tyrosine kinase inhibitors
What is the prognosis like for kidney cancers?
once staging crosses T3/T4, prognosis gets much worse
What are the consequences of radical nephrectomy?
with both kidneys removed, patient will need to be put on dialysis
What is the epidemiology of bladder cancer?
→ 10,200 new bladder cancer cases in the UK every year
→ Bladder cancer is the 11th most common cancer in the UK
→ Incidence and mortality declining
What are the different types of bladder cancer? What is their prevalence?
→ >90% = transitional cell carcinoma
→ 1-7% = squamous cell carcinoma (75% SCC where schistosomiasis is endemic),
→ 2% = Adenocarcinoma
???? What are the risk factors for bladder cancer?
→ smoking
→ old age
→ UTIs
What is the clinical presentation for bladder cancer?
→ Painless haematuria
→ persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
→ Suprapubic pain
→ Lower urinary tract symptoms
→ Metastatic disease symptoms –bone pain, lower limb swelling
What investigation are done for bladder cancer for painless visible haematuria?
→ Flexible cystoscopy
→ CT urogram
→ Renal function
What investigation are done for bladder cancer for persistent microscopic haematuria?
→ Flexible cystoscopy (often under general anaesthetic as you can do surgery at the same time)
→ transurethral resection of bladder lesion
→ US KUB (ultrasound for kidneys, ureters and bladder)
What’s the next step if biopsy shows muscle invasive bladder cancer?
→ staging investigations need to be done
→ muscle invasive cancer is treated differently to superficial cancers
How are bladder cancers staged?
→ Ta – non invasive papillary carcinoma
→ Tis – carcinoma in situ
→ T1 – invades subepithelial connective tissue
→ T2 – invades muscularis propria
→ T3 – invades perivesical fat
→ T4 – prostate, uterus, vagina, bowel, pelvic or abdominal wall
→ N1 – 1 Lymph Node below common iliac birufication
→ N2 – >1 LN below common iliac birufication
→ N3 – Mets in a common iliac LN
→ M1 – distant mets
