Urological cancers Flashcards
(57 cards)
How common I kidney cancer?
Incidence/ mortality trend?
- Kidney cancer is 7th most common cancer in UK
- Incidence and mortality rising
What types of kidney cancers are there and which is the most common?
Most are renal cell carcinomas (adenocarcinomas)
Transitional cell carcinomas
Sarcomas/Wilms tumor/ other types
What aetiological factors are there that cause kidney cancers?
Smoking
Hypertension
Renal failure and dialysis
Genetic predisposition with Von Hippel-Lindau syndrome (50% of individuals will develop RCC)
What clinical features can you find in kidney cancers?
-You may or may not feel a mass- if there is a mass there’s likely to be systemic symptoms too like weight loss or anaemic or polycythaemic (because of paraneoplastic syndromes), hypercalcaemia (again since tumour might secrete this)
- Loin pain
- Haemorrhage
-Varicocele
- Metastatic disease symptoms like bone pain, haemoptysis, shortness of breath
- Commonest- painless haematuria (particularly if large tumour like transitional cell carcinoma) or persistent microscopic haematuria- a red flag and can reflect urological malignancies
If you can’t find a mass how then do we often find kidney cancers?
A lot of them are incidentally found on scans
Where and why would you see varicocele in kidney cancer?
- left sided renal tumours
- You get compression of renal vein due to tumour thrombus
What investigations would we do on painless visible haematuria?
Ask a history about smoking, coagulation problems
CT urogram
Flexible cystoscopy
Renal function
What is CT urogram used for?
- The top end of the urinary system- CT scan of kidneys which could reveal masses
- Can look down ureters too to look for pathology there e.g. ureteric filling defect which could indicate transitional cell carcinomas or stones (which also cause haematuria)
- Get a little idea of the bladder but we don’t look at it directly- if we see a large bladder mass causing haematuria we might see a filling defect or clot in the bladder
What is flexible cystoscopy and what is it used to look for
- Looking at bladder under local anaesthetic- looking for exophytic lesions (looking for tumours) or bleeding from ureteric orifices which could mean bleed is higher (e.g. ureters) and its trickling down into bladder
- Can look at urethra for transitional cell carcinoma
- Can see strictures that cause haematuria or bleeding prostate
- Red patches in bladder could indicate pre-cancer or carcinoma in-situ
What investigations do we do on persistent non visible haematuria?
- Flexible cystoscopy
- US KUB (US of kidneys, ureter and bladder)
-((CT urogram))
What is non-visible haematuria?
When you see RBCs in urine on microscopy or dipstick but not visually
Which out of visible and non-visible haematuria are we more concerned about?
How would they present in clinic?
Other than bladder cancer what could this indicate?
- Visible because usually these cases have serious underlying pathology
- Often see them in clinic with large bladder and anaemic and have to wash out bladder because of clots
- Also have to check for visible haematuria to see if there’s a renal problem, esp if there’s proteinuria
How do we investigate a suspected renal cancer?
- CT renal triple phase
- Staging CT chest
- Bone scan if symptomatic
What staging system would we use for RCC?
TNM staging (see pic)
What grading system can we use for kidney cancer?
Fuhrman grade
- 1 = well differentiated
- 2 = moderately differentiated
- 3 + 4 = poorly differentiated
What is kidney cancer management dependent on?
Patient specific- depends on:
- ASA status (healthiness of patient)
- Comorbidities
- Classification of lesion
How do we manage kidney cancer in patients with small tumours who are unfit for surgery?
- Cryosurgery- freeze the lesion
- Can follow it up with serial scanning
What is the gold standard for management of kidney cancer?
Excision either via partial nephrectomy or radical nephrectomy (full kidney removal)
When would we do a partial nephrectomy?
- single kidney
- bilateral tumour
- multifocal RCC in patients with VHL (multiple small lesions)
- T1 tumours (up to 7cm)
How would we treat metastatic kidney disease?
- Receptor tyrosine kinase inhibitors
What do we want to avoid in resection of kidney cancer?
Taking out so much kidney that we have to put them on dialysis
Why is incidence and mortality of bladder cancer declining?
- more screening
- less patients are smoking
What types of bladder cancers are there?
> 90% are transitional cell carcinoma
squamous cell carcinoma
adenocarcinoma
complication of transitional cell carcinoma of the bladder?
- TCC arises from transitional epithelium which also lines ureter and kidney
- If you have a bladder cancer you could get a field change where the cancer travels all the way up from urethra to kidney
(therefore these patient need a CT scan to assess urothelium everywhere else)
