Urological cancers

Question 1

Types of blood in the urine

Answer 1

Microscopic haematuria
Visible haematuria (more serious)

Question 2

How to analyse urine

Answer 2

urine dipstick
microscopy to exclude infections

Question 3

What are three examples of kidney cancer?

Answer 3

85% Renal Cell Carcinoma,
10% Transitional Cell Carcinoma,
5% Sarcoma/other types

Question 4

What are the risk factors of kidney cancer?

Answer 4

Smoking,
Age
hep C
Obesity,
Dialysis,
BP,
Genes

Question 5

What are the red flag symptoms of kidney cancer?

Answer 5

Painless (visible) haematuria // Persistent Microscopic Haematuria

Question 6

What are the additional features of renal cell carcinoma?

Answer 6

Loin pain,
palpable mass,
metastatic symptoms, paraneoplastic symptoms where tumours can release certain hormones. can also result in bone pain

Question 7

Symptoms of renal cancer

Answer 7

Haematuria
back pain
weight loss
loss of appetite
fatigue
fever
anaemia
night sweats

Question 8

What are the investigations for painless visible haematuria?

Answer 8

Flexible cytoscopy, CT urogram

Question 9

What are the investigations of persistent non-visible haematuria?

Answer 9

Flexible Cystoscopy, (not typically used for those under 40)
Ultrasound KUB (with Xray)

Question 10

What grading can you do for kidney cancer?

Answer 10

Fuhrman Grade

Question 11

Describe the fuhrman grading process

Answer 11

Fuhrman Grade: 1-4 (1 - well-differentiated / 4 - poorly differentiated)

Question 12

What staging can you do for kidney cancer

Answer 12

TNM- tumour, node, metastasis

Question 13

What is the most common management process for kidney cancer?

Answer 13

Excision via:
partial nephrectomy - preserve kidney function
radical nephrectomy

Question 14

What is the management for patients with small tumours unfit for surgery?

Answer 14

Cryosurgery (cold probe to freeze and destroy tumour)

Question 15

What is the management for patients with metastatic disease?

Answer 15

Receptor Tyrosine Kinase Inhibitors

Question 16

What are three examples of bladder cancer?

Answer 16

90% Transitional Cell Carcinoma,
8% Squamous Cell Carcinoma, High incidence in areas where schistosomiasis is endemic
2% Adenocarcinoma

Question 17

What are the risk factors of bladder cancer?

Answer 17

Smoking,
Bladder Inflammation,
Chronic infection,
Catheterisation,
Radiotherapy,
Drugs (Cyclophosphamide)

Question 18

What are the red flag symptoms of bladder cancer?

Answer 18

Painless (macroscopic) haematuria
Persistent Microscopic Haematuria

Question 19

What are the additional features of bladder cancer?

Answer 19

Suprapubic pain,
UTI,
metastatic symptoms - bone pain, lower limb swelling

Question 20

Symptoms of bladder cancer

Answer 20

Haematuria
irritative symptoms - dysuria, nocturia
obstructive symptoms

Question 21

What is the classification of bladder cancer?

Answer 21

TNM, WHO Classification

Question 22

Investigations for bladder cancer

Answer 22

Cystoscopy
Ct urogram

Question 23

WHO classification process

Answer 23

G1 - G3 (G1 - well differentiated // G3 - poorly differentiated)

Question 24

What is the problem with CT scans when diagnosing bladder cancer

Answer 24

Cannot differentiate between blood clot and tumour
the resolution is poor .: cystoscopy is used

Question 25

How can you remove a visible bladder tumour?

Answer 25

Transurethral Resection - uses heat to cut out tumour via cystoscopy

Question 26

What are the two types of bladder cancer?

Answer 26

Muscle-invasive // Non muscle-invasive

Question 27

What is the management protocol for non-muscle invasive bladder cancer?

Answer 27

Cystoscopy, Intravesicular chemotherapy

Question 28

What is the management protocol for muscle invasive bladder cancer?

Answer 28

Cystectomy, Radiotherapy, Palliative treatment

Question 29

Uretic TCC symptoms

Answer 29

Obstruction to the bladder renal issues

Question 30

Main type of prostate cancer

Answer 30

Adenocarcinoma

Question 31

Risk factors of prostate cancer

Answer 31

age scandinavian countries ethnicity - african family history obesity diet

Question 32

What is the chronicity of prostate cancer like?

Answer 32

Asymptomatic usually until metastatic

Question 33

What blood test can you do for prostate cancer?

Answer 33

PSA (prostatic specific antigen) age specific ranges as it increases in size with age

Question 34

What is the problem with using PSA?

Answer 34

PSA is only prostate-specific (not cancer specific), so elevated in UTI, prostatitis, BPH (benign prostatic hypertrophy)

Question 35

What imaging would you use for prostate cancer investigations?

Answer 35

MRI look at diffusion of contrast to show volume of prostate and highlight focal areas of abnormality

Question 36

What biopsy do you use in prostate cancer investigations?

Answer 36

Trans-perineal Prostate Biopsy - low risk of infection, allows sample of all areas of the prostate

Question 37

Classification of prostate cancer

Answer 37

TNM, Gleason Score

Question 38

Describe the gleason score grading process?

Answer 38

Gleason Score: 2-6 (well differentiated - bad) // 8 - poorly differentiated

Question 39

Describe the T grades of TNM staging of prostate cancer?

Answer 39

T1 - too small to seen on scan, just felt (1a,b,c based on prevalence in tissue) // T2 - inside of prostate gland (2a,b,c - which side of prostate gland or both) // T3 - broken through prostate capsule (3a,b - just capsule or into seminal vesicles) // T4 - spread into nearby organs or pelvis wall

Question 40

Describe the N grades of TNM staging of prostate cancer?

Answer 40

N0 - not spread to lymph nodes // N1 - spread to lymph nodes

Question 41

Describe the M grades of TNM staging of prostate cancer?

Answer 41

M0 - not spread to other parts of the body // M1 - spread outside pelvis (1a,b,c - lymph, bone)

Question 42

What are the two elements of patient classification that influence management of prostate cancer?

Answer 42

Age/Fitness & Grade of Cancer

Question 43

What is the management of a young and fit patient with low grade cancer?

Answer 43

Surveillance - PSA, MRI and bone surveillance

Question 44

What is the management of a young and fit patient with high grade cancer?

Answer 44

Radical prostatectomy & Radiotherapy

Question 45

What is the management of an old and unfit patient with low grade cancer?

Answer 45

Surveillance - regular PSA

Question 46

What is the management of an old and unfit patient with high grade cancer?

Answer 46

Hormone Therapy | used for mets/recurrence

Question 47

What are the two structures that can be damaged in prostatectomy?

Answer 47

Removal of proximal urethral sphincter - results in shorter urethra (risk of utis, urinary retention) Damage to cavernous nerves - ED, lower bladder innervation issues

Question 48

Mnemonic for Cancer red flags

Answer 48

Fever Lethargy Anorexia Weight loss Sweats (at night)