Urological Cancer Flashcards
When would you refer a patient on the 2ww pathway
-when would you refer via the non urgent pathway
45+ with
- unexplained visible hematuria without UTI
- visible hematuria that persists after UTI treatment
60+ with
-unexplained non visible hematuria AND dysuria OR raised WBC
Non urgent
60+ with unexplained persistent UTIs
Presentation
Painless visible hematuria
Have they had this before, has it been investigated in the past
Constantly visible blood or intermittent
Voiding/storage urinary symptoms
Flank, bladder, urethral pain
SMOKER
Conditions you would like to rule out
Current and past history of
- stones
- other urological cancers
- urological procedures - stents
- travel to Africa - contact with fresh water
- recent infections - pyelonephritis, TB
- BPH
Medical history
Rifampicin, anticoagulant related bleeding
Investigations for
- upper urinary tract
- lower urinary tract
- other important investigations
Why do USS
Dipstick to assess for NVH
Upper (kidney, ureter)
FIRST LINE - US+XRay
Do CT KUB(stones)/urogram(with contrast if
-no explanation for VH with USS/inconclusive
-upper tract symptoms
-smoker 50+
Lower (bladder, urethra)
-cystoscopy
Identify if a nephrological hematuria
- NVH
- proteinuria or high BP/raised creatinine with no obstructive cause
USS
- faster, easier, accurate
- no radiation or contrast allergy
- no GFR testing
2 main types of bladder cancer
-management
Management of renal cancer
Non muscle invasive - majority of cancers
- transurethral resection to muscle layer
- adjuvant
Muscle invasive
- neoadjuvant chemo
- radical cystectomy
- adjuvant chemo
Renal cancer
-depending on staging - partial/radical nephrectomy
Epidemiology of prostate cancer
Risk factors
Most common cancer in men
Risk increases with age
Age
Race - black
Family
Presentation of prostate cancer
Early - none
LUTS
Late - hematuria/LUTS/bone pain/weight loss
PSA
- normal reasons for high PSA
- abnormal reasons for high PSA
PSA formed in prostate => secreted into prostatic ducts
Some leaks into blood and can be measured
Normal elevation
- UTI
- prostate stimulation/recent ejaculation/anal sex
- recent vigourous exercise
- BPH
Abnormal elevation
-prostate cancer
When to refer for 2ww for prostate cancer
Prostate feels malignant on DRE
PSA in men with -LUTS -erectile dysfunction -VH Refer if PSA above age specific range
Presentation of prostate cancer
-past medical history
Incidental high PSA
Abnormal DRE
LUTS Hematuria/hematospermia Voiding/storage urinary symptoms New bone pain Weight loss
Past urological surgery
Past urological cancers/procedures
FHx
Symptoms despite being on tamulosin/finasteride (for BPH)
Age, ethnicity
Investigations for prostate cancer
-possible outcomes
DRE
Urine dip - rule out UTI
Flow rate - impact on their urination, may raise PSA
PSA
Determine cause of high PSA with prostate MRI
Benign, BPH => depends on symptoms (medication/minimally invasive organ sparing surgery)
Inflammatory disease, prostatitis => ABx
Suspected prostate cancer => biopsy to confirm
- transrectal/transperineal
- rated on Gleason score
PETCT to assess for any bony mets
Management for prostate cancer
Ranges from
- active surveillance - can intervene if progression found
- watchful waiting
- radical prostatectomy
- radiotherapy
Androgen deprivation therapy
- LHRHa competes with LH => down regulation of T
- antiandrogens
Side effects of prostate cancer treatment
Infertility
Inpotence
Incontinence
Epidemiology of testicular cancer
Most common in 20-40s
Rapid progression
Presentation of testicular cancer
Risk factors
Rapid progression
Weight loss
Back pain - bony mets?
Neurological symptoms
Risk factors
- subfertility
- HIV
- FHx
- smoking
- Klinefelters/undescended testis
- contralateral testicular cancer
