Urological cancers

Question 1

Name some risk factors for kidney cancer.

Answer 1

smoking
obesity
chemotherapy
hypertension
genetics

Question 2

What type of cancer are the majority of kidney cancers?

Answer 2

renal cell carcinoma (adenocarcinoma)

Question 3

Apart from renal cell carcinoma (adenocarcinoma), what other types of kidney cancers are there?

Answer 3

transitional cells carcinoma
Sarcoma / Wilms tumour + other types

Question 4

Name some clinical features of kidney cancer.

Answer 4

painless haematuria (visible or microscopic)
loin pain
palpable mass
metastatic disease symptoms

Question 5

What are some investigations we can do for painless visible haematuria?

Answer 5

flexible cystoscopy

CT urogram (can’t see bladder very well, so use contract and look at ureters)

renal function (proteinurea, haematuria, urine cytology)

Question 6

What are some investigations we can do for painless non-visible haematuria?

Answer 6

Flexible cystoscopy

US KUB

Question 7

What are some investigations we can do for suspected kidney cancer?

Answer 7

CT renal triple phase
staging CT chest
bone scan if symptomatic

Question 8

Memorise

Question 9

What is The Fuhrman Nuclear Grade?

Answer 9

a pathology component of renal cell cancers and an independent predictor of cancer-specific survival.

Question 10

How is the Fuhrman grade scored?

Answer 10

Question 11

What is the management for kidney cancer?

Answer 11

patient specific

gold standard is excision via:
- partial nephractomy
or
- radical nephrectomy

Question 12

What is nephron/renal sparing surgery?

Answer 12

in a partial nephrectomy — also called kidney-sparing (nephron-sparing) surgery — the surgeon removes a cancerous tumor or diseased tissue and leaves in as much healthy kidney tissue as possible

Question 13

What is a partial nephrectomy aka?

Answer 13

kidney/nephron-sparing surgery

Question 14

How do we manage kidney cancer patients who have small tumours, but are unfit for surgery?

Answer 14

cryosurgery

freeze and follow up w/ regular scans

Question 15

How can we manage kidney cancer patients with metastatic disease?

Answer 15

receptor tyrosine kinase inhibitors

Question 16

What is the most common type of bladder cancer?

Answer 16

transitional cell carcinoma
(epithelium)

Question 17

What type of bladder cancer is very aggressive, but is only about 1-7% of cases?

Answer 17

squamous cell carcinoma

Question 18

Under what specific circumstance is 75% of squamous cell carcinoma of bladder seen?

Answer 18

where schistosomiasis is endemic

Question 19

Name the 3 types of bladder cancer.

Answer 19

transitional cell carcinoma
squamous cell carcinoma
adenocarcinoma

Question 20

Name some clinical features of bladder cancer.

Answer 20

painless haematuria / persistent microscopic haematuria

Suprapubic pain

Lower urinary tract symptoms and UTI

Metastatic disease symptoms

Question 21

What condition of the kidney can occur in advanced bladder cancer?

Answer 21

hydronephrosis

Question 22

How should we continue investigations in a bladder cancer that has been proven to invade the muscle?

Answer 22

staging investigations

Question 23

How does WHO classify bladder cancers?

Answer 23

Question 24

Describe the TNM staging of bladder cancer.

Answer 24

Question 25

What procedure can provide histology as well as be curative for a bladder lesion?

Answer 25

Cystoscopy + transurethral resection of bladder lesion

Question 26

We can divide bladder cancer into non-muscle invasive and muscle invasive. How do we manage each type?

Answer 26

Question 27

What is BCG?

Answer 27

BCG is a type of immunotherapy drug. For bladder cancer, BCG is given directly into the bladder (intravesical). This can make the bladder react in a way that makes the immune system get rid of cancer cells.

Question 28

What is the most common cancer in the UK for men?

Answer 28

prostate

Question 29

What type of cancer are the majority of prostate cancers?

Answer 29

adenocarcinoma

Question 30

Name some clinical features of prostate cancer.

Answer 30

usually asymptomatic unless metastatic urinary symptoms are actually not that common but can have metastatic symptoms, like bony pain

Question 31

What is PSA?

Answer 31

PSA liquifies the ejaculate it can be tested for in blood tests and it is prostate-specific but not prostate-cancer specific

Question 32

When can PSA be elevated?

Answer 32

prostate cancer UTI prostatitis BPH

Question 33

How do we investigate for prostate cancer?

Answer 33

blood tests multiparametric MRI before biopsy or MRI targeted biopsy (gold standard) transperineal prostate biopsy

Question 34

How is transperineal prostate biopsy graded?

Answer 34

/10, greater, higher risk

Question 35

How do we score prostate cancer?

Answer 35

Question 36

How do we TNM stage prostate cancer?

Answer 36

Question 37

Prostate cancer management is highly dependent on patient age/comorbidities and stage and grade of prostate cancer: How do we manage someone who is: - young and fit with high grade cancer? - young and fit with low grade cancer?

Answer 37

high grade -> radical prostatectomy / radiotherapy low grade -> active surveillance (regular PSA, MRI and biopsy)

Question 38

Prostate cancer management is highly dependent on patient age/comorbidities and stage and grade of prostate cancer: How do we manage someone who is: - old and unfit with high grade cancer? - old and unfit with low grade cancer?

Answer 38

high grade/metastatic disease -> hormone therapy low grade -> watching waiting (regular PSA)

Question 39

How do we manage post-prostatectomy?

Answer 39

monitor PSA (should be undetectable or <0.01ng/ml) if >0.2ng = relapse

Question 40

What are the treatment side effects of prostatectomy? (4)

Answer 40

The prostate contains the proximal sphincter Prostatectomy removes the proximal urethral sphincter and changes urethral length Risk of damage to cavernous nerves (innervation to bladder and urethra) Damage to cavernous nerves causes ED.

Question 41

Patients with suspected prostate cancer should undergo _____

Answer 41

MRI imaging

Question 42

Incidence of testicular cancer is ___

Answer 42

increasing

Question 43

How does WHO classify testicular cancers by ABC?

Answer 43

A: germ cell tumours B: sex cord / gonadal stromal C: miscellanenous

Question 44

Name some germ cell testicular tumours.

Answer 44

Question 45

Name some sex cord / gonadal stromal tumours.

Answer 45

Question 46

Name some miscellaneous tumours.

Answer 46

lymphoma metastases rete tumours paratesticular tumours mesenchymal (sarcomatous) tumours

Question 47

How can we classify primary tumours? (pT)

Answer 47

Question 48

What do these stages mean? IA IB IS

Answer 48

Question 49

Name the 3 principal serum tumour markers for testicular cancer.

Answer 49

Alpha-fetoprotein (AFP) B eta subunit of human chorionic gonadotropin (HCG) Lactate dehydrogenase (LDH)

Question 50

Describe AFP as a testicular cancer serum tumour marker.

Answer 50

Question 51

Describe beta-subunit HCG as a testicular cancer serum tumour marker.

Answer 51

Question 52

Describe LDH as a testicular cancer serum tumour marker.

Answer 52

Question 53

What are the guidelines for diagnosis and staging of testicular cancer?

Answer 53

Question 54

How can we diagnose testicular cancer?

Answer 54

Question 55

What is a surgery to remove a testicle with cancer is called?

Answer 55

a radical inguinal orchiectomy

Question 56

For a seminoma, what is the pathological prognostic factor in a stage I disease?

Answer 56

tumour size >4cm rete invasion (stromal)

Question 57

For a non-seminomatous tumour, what is the pathological prognostic factor in a stage I disease?

Answer 57

- lymphovascular invasion - presence (and extent) of embryonal carcinoma

Question 58

What are some symptoms of penile cancer?

Answer 58

* Inability/ difficulty / pain on retracting foreskin * Spraying of stream * Obstructive LUTS * Association with penile cancer

Question 59

What do we call the condition in which tight foreskin can't be pulled back over the head of the penis.

Answer 59

phimosis

Question 60

What do we call an abnormal narrowing of the urethral opening? How can this present physiologically?

Answer 60

meatal stenosis spraying of stream

Question 61

What can obstructive LUTS be caused by?

Answer 61

urethral stricture

Question 62

It is difficult to distinguish penile cancer from ____

Answer 62

benign penile dermatoses

Question 63

In penile cancer, you should also examine for regional inguinal ______ .

Answer 63

lymphadenopathy

Question 64

How do we TNM classify penile cancer?

Answer 64

Question 65

Incidence of penile cancer is ___ in LMIC. Incidence of testicular cancer is ___ in HIC.

Answer 65

higher higher

Question 66

What is the management for kidney cancer?

Answer 66

patient specific gold standard is excision via: - partial nephrectomy or - radical nephrectomy