Urological Cancers Flashcards
(86 cards)
1
Q
What are the different types of kidney cancer?
A
- Renal cell carcinoma (85%)
- Transitional cell carcinoma (10%)
- Sarcoma/Wilms/Other (5%)
2
Q
What are the risk factors of kidney cancer?
A
- older age
- smoking
- renal failure
- dialysis
- obesity
- hypertension
- Hep C
- Von Hippel-lindau syndrome (genetic) , 50% develop kidney cancer
3
Q
What is a red flag symptom of kidney/urological malignancy?
A
- painless visible haematuria
- persistant microscopic haematuria
4
Q
What are the key features of renal cell carcinoma?
A
- loin pain
- palpable mass
- metastatic disease symptoms (bone pain, haemoptysis)
5
Q
What are the symptoms of renal cancer?
A
- visible haematuria (pink, red or cola coloured)
- back pain below ribs
- unexplained weight/appetite loss
- fatigue
- fever
- lump on your side, belly or lower back
- anaemia
- night sweats
- hypertension
- hypercalcaemia
6
Q
What should be done when painless visible haematuria is seen?
A
- flexible cystoscopy
- CT urogram
- Renal function
7
Q
What should be done when persistent non-visible haematuria is found?
A
- flexible cystoscopy
- US KUB
8
Q
What investigations should be done when kidney cancer is suspected?
A
- CT renal triple phase
- staging CT chest
- bone scan if symptomatic
9
Q
What is the Fuhrman tumour grading system?
A
1 - well differentiated
2 - moderate differentiated
3+4 - poorly differentiated
10
Q
What does a classification of T1 of TNM tumour staging mean for kidney cancer?
A
Tumour ≤ 7cm
11
Q
What does a classification of T2 of TNM tumour staging mean for kidney cancer?
A
Tumour >7cm
12
Q
What does a classification of T3 of TNM tumour staging mean for kidney cancer?
A
Extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia
13
Q
What does a classification of T4 of TNM tumour staging mean for kidney cancer?
A
Tumour beyond perinephric fascia into surrounding structures
14
Q
What does a classification of N1 of TNM tumour staging mean for kidney cancer?
A
Metastasis in single regional LN
15
Q
What does a classification of N2 of TNM tumour staging mean for kidney cancer?
A
Metastasis in ≥2 regional LN
16
Q
What does a classification of M1 of TNM tumour staging mean for kidney cancer?
A
distant metastasis
17
Q
What is the management of kidney cancer dependent on?
A
patient specific, depends on:
- ASA status
- Co-morbidities
- Classification of lesion
18
Q
What is the gold standard management of kidney cancer?
A
excision via:
- Partial nephrectomy
- Radical Nephrectomy
19
Q
When is a partial nephrectomy done?
A
- single kidney
- bilateral tumour
- multifocal RCC in patients with VHL
- T1 tumours (up to 7cm)
20
Q
What is the management of kidney cancer for patients with small tumours unfit for surgery?
A
cryosurgery
21
Q
What is the management of kidney cancer with metastatic disease?
A
- receptor tyrosine kinase inhibitors
- immunotherapy
22
Q
What are the different types of bladder cancer?
A
- Transitional cell carcinoma (>90%)
- squamous cell carcinoma (1-7%) - (75% with endemic schistosomiasis)
- adenocarcinoma (2%)
23
Q
What are the risk factors of bladder cancer?
A
- smoking
- occupational exposure
- chronic inflammation of the bladder (stones, schistosomiasis, long term catheter)
- drugs (cyclophosphamide)
- radiotherapy
24
Q
What is a red flag symptom of bladder/urological malignancy?
A
- painless visible haematuria
- persistant microscopic haematuria
25
What are the other clinical features of bladder cancer?
- suprapubic pain
- lower urinary tract symptoms
- UTIs
- metastatic disease symptoms (bone pain, lower limb swelling)
26
What are the key symptoms of bladder cancer?
- haematuria
- dysuria
- nocturia
- urge incontinence
- obstructive symptoms when urinating
- abdominal, bone, flank and pelvic pain
- anorexia
- cachexia
- lower edema
- renal failure
- resp symptoms
- suprapubic palpable mass
27
What does a classification of T1 of TNM tumour staging mean for bladder cancer?
invades subepithelial connective tissue
28
What does a classification of T2 of TNM tumour staging mean for bladder cancer?
invades muscularis propria
29
What does a classification of T3 of TNM tumour staging mean for bladder cancer?
invades perivesical fat
30
What does a classification of T4 of TNM tumour staging mean for bladder cancer?
invades prostate, uterus, vagina, bowel, pelvic or abdominal wall
31
What does a classification of N1 of TNM tumour staging mean for bladder cancer?
1 LN below common iliac birufication
32
What does a classification of N2 of TNM tumour staging mean for bladder cancer?
>1 LN below common iliac birufication
33
What does a classification of N3 of TNM tumour staging mean for bladder cancer?
Mets in a common iliac LN
34
What does a classification of M1 of TNM tumour staging mean for bladder cancer?
distant mets
35
What does a classification of Ta of TNM tumour staging mean for bladder cancer?
non invasive papillary carcinoma
36
What does a classification of Tis of TNM tumour staging mean for bladder cancer?
carcinoma in situ
37
What does a G1 WHO classification of bladder cancer mean?
well differentiated
38
What does a G2 WHO classification of bladder cancer mean?
moderately differentiated
39
What does a G3 WHO classification of bladder cancer mean?
poorly differentiated
40
What happens in a cystoscopy and transurethral resection of bladder lesion
- use of heat to cut out all visible bladder tumour
- provides histology and possibly curative
- if tumour extends beyond muscle, resection is incomplete to prevent bladder perforation
41
What does the management of bladder cancer depend on?
whether or not it has invaded the muscle
42
What is the management protocol if the bladder tumour is non-muscle invasive?
If low grade and no CIS
- cystoscopic surveillance
- +/- intravesicular chemotherapy/BCG
43
What is the management protocol if the bladder tumour is muscle invasive?
- Cystectomy
- Radiotherapy
- +/- chemotherapy
- Palliative treatment
44
What type of cancer is prostate cancer?
adenocarcinoma (>95%)
45
What are the risk factors of prostatic cancer?
- age
- western nations (scadivanians)
- ethnicity (african americans)
- FHx
- obesity
- diet
46
What are the clinical features of prostate cancer?
usually asymptomatic unless metastatic
47
What investigations are done when prostate cancer is suspected?
- blood tests
- MRI
- Trans perineal prostate biopsy
48
What blood tests are done when prostate cancer is suspected?
PSA - prostate specific antigen
49
What is PSA?
- enzyme produced by the prostate
- detectable levels only produced by prostate tissue
- may be increased by trauma to the prostate
- can increased with age since age comes with prostatic enlargment
- cannot be used alone to diagnose prostate cancer
50
What can cause a raised PSA?
- UTI
- Prostatitis
- Benign Prostatic Hyperplasia
- Prostate cancer
51
What MRIs are done when prostate cancer is suspected?
multiparametric MRI
52
What is the current gold standard investigations for detecting prostate cancer?
- multiparametric MRI
- MRI targeted biopsy
53
What is a Trans perineal prostate biopsy?
Systematic template biopsies of the prostate
54
Why are Trans perineal prostate biopsies commonly used?
- less risk of infection
- able to sample all areas of the prostate.
55
What does a classification of T1 of TNM tumour staging mean for prostate cancer?
non palpable or visible on imaging
56
What does a classification of T2 of TNM tumour staging mean for prostate cancer?
palpable tumour
57
What does a classification of T3 of TNM tumour staging mean for prostate cancer?
beyond prostatic capsule into periprostatic fat
58
What does a classification of T4 of TNM tumour staging mean for prostate cancer?
tumour fixed onto adjacent structure/pelvic side wall
| - spread to other nearby organs (bladder, pelvic wall, rectum)
59
What does a classification of N1 of TNM tumour staging mean for prostate cancer?
regional Lymphnodes (pelvis)
60
What does a classification of M1a of TNM tumour staging mean for prostate cancer?
cancer cells in lymphnodes outside the pelvix
61
What does a classification of M1b of TNM tumour staging mean for prostate cancer?
cancer cells are found in the bone
62
What does a classification of M1x of TNM tumour staging mean for prostate cancer?
cancer has spread to other parts of the body outside the pelvixother sites
63
What does a Gleason score of 2-6 of prostate cancer mean?
well differentiated
64
What does a Gleason score of 7 of prostate cancer mean?
moderately differentiated
65
What does a Gleason score of 8 of prostate cancer mean?
poorly differentiated
66
What does a classification of T1a of TNM tumour staging mean for prostate cancer?
cancer is <5% of removed tissue
67
What does a classification of T1b of TNM tumour staging mean for prostate cancer?
cancer is >/=5% of removed tissue
68
What does a classification of T1c of TNM tumour staging mean for prostate cancer?
found by biopsy (often after a raised PSA level)
69
What does a classification of T2a of TNM tumour staging mean for prostate cancer?
cancer is only in 1/2 of one side of the prostate
70
What does a classification of T2b of TNM tumour staging mean for prostate cancer?
cancer in more than 1/2 of one side of the prostate (not both)
71
What does a classification of T2c of TNM tumour staging mean for prostate cancer?
in both sides of the prostate gland, but still inside the prostate gland
72
What does a classification of T3a of TNM tumour staging mean for prostate cancer?
cancer has broken through the capsule of the prostate gland
73
What does a classification of T3b of TNM tumour staging mean for prostate cancer?
cancer has spread into the seminal vesicles
74
What does a classification of N0 of TNM tumour staging mean for prostate cancer?
nearby lymphnodes don't contain cancer cells
75
What is the management of prostate cancer dependent on?
- patient age
- co-morbidities
- stage and grade of prostate cancer
76
What is the management of prostate cancer if the patient is young and fit with high grade cancer?
- radical prostatectomy
- radiotherapy
77
What is the management of prostate cancer if the patient is young and fit with low grade cancer?
active surveillance
- PSA, and DRE/quaterly
- MRI (occasionally biospies)/annually
78
What is the management of prostate cancer if the patient is old and unfit with high grade cancer?
hormone therapy
79
What is the management of prostate cancer if the patient is old and unfit with low grade cancer?
watchful waiting (regular PSA testing)
80
What should be done post prostatectomy?
- monitor PSA for relapse/6 months
| should be undetectable
81
What is an undetectable PSA level?
<0.01ng/ml
82
What PSA level would indicate a relapse?
>0.2ng/ml
83
What is the impact of a prostatectomy on continence?
- contains the proximal sphincteric unit
- removes the proximal urethral sphincter
- risk of damage to the cavernous nerve impacting bladder function
- changes in urethral length
84
What is the main treatment for the continence issues cause by a prostatectomy?
- PFE
- artificial urinary sphincter device
85
What is the impact of cavernous nerve damage?
- erectile dysfunction
- bladder dysfunction (responsible for bladder and urethra innervation)
86
What is involved in the treatment of erectile dysfunction caused by cavernous nerve damage?
- PDE5 inhibitors
- prostaglandin E1 injections
- Penile prosthesis devices
