Urological cancers Flashcards
what are the two forms of haematuria and what has the higher risk of malignancy?
non visible and visible
visible has a higher risk of malignancy and is a symptom of urological cancer
if a patient is over 60 and presents with visible haematuria to their gp, whats the next step for treatment?
attend haematuria clinic, a one stop clinic where you do test so that by the end of the day you know whether they have cancer or not
what do you check in a one stop clinic for suspected urological cancers?
1) history - smoking, occupational exposure (rubber, dyes, paints), past history of radiotherapy
2) examination and DRE in men
3) bloods - U&E, PSA, FBC
4) Urine dip
5) ultrasound of renal tract to detect renal and bladder masses and hydronephrosis
6) flexible cystoscopy, mainly diagnostic as can take biopsies
what cancers do you check for in a one stop haematuria clinic?
look for kidney, bladder and prostate cancer (prostate usually has to be quite bad to cause haematuria)
which is more specific for a UTI, nitrites or leucocytes?
nitrites are more specific
Leucocytes however are more sensitive for UTI
where is a CT Urogram a useful test?
its sensitive for upper tract transition cell carcinomas
when is a flexible cystoscopy not useful?
during active bleeding as views are generally poor (requires washout)
what are 4 causes of haematuria?
tumours
infection
trauma
stones
how are tumours graded and staged?
Grades
G1 - well differentiated
G2 - moderately well differentiated
G3 - poorly differentiated
Staging = TNM staging
Tis, Ti, Ta - in situ, doesn’t invade detrusor muscle. A non invasive bladder cancer. 75%
T2, T3, T4 (basically T2 onwards) - detrusor muscle invasive bladder cancers. 25%
histology from a transurethral resection of bladder tumour is done to do this
what are the treatments for bladder cancer?
1) surgery = radical cystectomy
NB: non cancer reason for bladder removal is a simple cystectomy
2) radiotherapy
how can a bladder tumour be resected?
transurethral resection of a bladder tumour is done with a rigid respect-scope and is done under a general or spinal anaesthetic, then can send to pathology to get a grade and TNM staging
what are the two carcinomas that develop in the kidneys and renal pelvis?
renal cell carcinoma and transitional cell carcinoma (TCC is most common)
what carcinomas develop in the ureter and bladder and what are they associated with?
Transitional cell carcinoma (less commonly squamous cell and adenocarcinoma)
squamous cells are associated with long term catheters, recurrent UTI and bladder stones in the UK
TCC are associated with smoking mainly
why do renal cell carcinomas receive neoadjuvant therapy before operation?
neoadjuvant therapy for 3 months prior to surgery increases benefit by 5% and as success is 50% at 5 years this is a massive benefit
what the types of urinary diversion?
1) ileal conduit/ incontinent diversion/ a urostomy (no control over urine outflow into stoma)
2) continent diversion (can control urine outflow into stoma by inserting catheter yourself)
3) Neobladder - ureters are connected to new bladder made of small bowel and connected to urethra
4) bilateral nephrostomy - potential in people with IBD who have already undergone bowel resection.
