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Year 2 Uro > Urological Cancers > Flashcards

Urological Cancers Flashcards

(45 cards)

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1
Q

Describe the epidemiology of kidney cancer?

A

13,100 new kidney cancer cases in the UK every year
Kidney cancer is the 7th most common cancer in the UK
Incidence and mortality rising

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2
Q

What are the types of kidney cancer?

A

85% Renal Cell carcinoma(adenocarcinoma)

10% transitional cell carcinoma

Sarcoma/Wilms tumour/other types(5%)

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3
Q

What are the risk factors for kidney cancer?

A

Smoking
Obesity
Genetics

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4
Q

What are the clinical features of kidney cancer?

A

Painless haematuria/persistent microscopic haematuria - red flag

Loin pain
Palpable mass
Metastatic disease symptoms – bone pain, haemoptysis

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5
Q

What investigations are done in anyone presenting with painless visible haematuria?

A

Flexible cystoscopy
CT urogram
Renal function

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6
Q

What investigations are done in anyone presenting with persistent non visible haematuria?

A

Flexible cystoscopy
US KUB
Less associated with cancer than visible

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7
Q

What investigations are done if kidney cancer is suspected?

A

CT renal triple phase
Staging CT chest
Bone scan if symptomatic

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8
Q

What are the TNM staging guidelines for kidney cancer? (T)

A

T1 – Tumour ≤ 7cm
T2 – Tumour >7cm
T3 – Extends outside kidney but not beyond ipsilateral adrenal or perinephric fascia
T4 – Tumour beyond perinephric fascia into surrounding structures

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9
Q

What are the TNM staging guidelines for kidney cancer? (N)

A

N1 – Met in single regional lymph node

N2 – met in ≥2 regional ly,ph node

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10
Q

What are the TNM staging guidelines for kidney cancer? (M)

A

M1- distant met

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11
Q

What is grading?

A

Looks at histology

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12
Q

How is kidney cancer graded?

A

1 = well differentiated
2 = moderate differentiated
3 + 4 = poorly differentiated

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13
Q

What is considered when choosing management of kidney cancer?

A

Patient specific

depends on the ASA status, comorbidities, classification of lesion

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14
Q

What does ASA status assess?

A

How fit a patient is

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15
Q

What is the gold standard treatment for kidney cancer?

A

Excision via:

Partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours (up to 7cm)

OR

Radical Nephrectomy

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16
Q

What can be done in patients who are unfit for surgery with small kidney tumours?

A

Cryosurgery

Freeze the lesion to stop progression

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17
Q

What is the treatment for metastatic kidney cancer?

A

Receptor Tyrosine Kinase inhibitors

Blocks cell signalling pathway - less angiogenesis, less spread

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18
Q

Describe the epidemiology of bladder cancer?

A

10,200 new bladder cancer cases in the UK every year
Bladder cancer is the 11th most common cancer in the UK
Incidence and mortality declining

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19
Q

What are the types of bladder cancer?

Study These Flashcards
A

> 90% transitional cell carcinoma

1-7% squamous cell carcinoma (75% SCC where schistosomiasis is endemic)

Adenocarcinoma(2%)

20
Q

What are the risk factors for bladder cancer?

Study These Flashcards
A

Smoking
Radiotherapy for other cancers
Chronic inflammation e.g. schistosomaisis
Occupational e.g. dye industry

21
Q

What are the clinical features of bladder cancer?

Study These Flashcards
A

Painless haematuria/persistent microscopic haematuria - red flag symptom of all urological cancers

Suprapubic pain
Lower urinary tract symptoms
Metastatic disease symptoms –bone pain, lower limb swelling

22
Q

What are the TNM staging guidelines for bladder cancer? (T)

Study These Flashcards
A

Ta – non invasive papillary carcinoma
Tis – carcinoma in situ
T1 – invades subepithelial connective tissue
T2 – invades muscularis propria
T3 – invades perivesical fat
T4 – prostate, uterus, vagina, bowel, pelvic or abdominal wall

23
Q

What are the TNM staging guidelines for bladder cancer? (N)

Study These Flashcards
A

N1 – 1 LN below common iliac birufication
N2 - >1 LN below common iliac birufication
N3 – Mets in a common iliac LN

24
Q

What are the TNM staging guidelines for bladder cancer? (M)

Study These Flashcards
A

M1- distant mets

25
How is bladder cancer graded?
``` G1 = well differentiated G2 = moderate differentiated G3 = poorly differentiate ```
26
What is the management protocol for non-muscle invasive bladder cancer?
If low grade and no carcinoma in situ - consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG (elicits inflammatory response to reduce progression of lesion)
27
What is the management protocol for muscle invasive bladder cancer?
Cystectomy Radiotherapy +/- chemotherapy Palliative treatment
28
Describe the epidemiology of prostate cancer?
48,500 new prostate cancer cases in the UK every year Prostate cancer is the most common cancer in men within the UK Incidence rising but mortality rates declining
29
What are the types of prostate cancer?
>95% of prostate cancer is adenocarcinoma
30
What are the risk factors for prostate cancer?
Age Western nations African-americans
31
What is important about prostate cancer?
Often asymptomatic unless metastatic
32
What blood test is done to investigate prostate cancer?
PSA is prostate-specific but no prostate-cancer specific | Can be elevated in (UTI, prostatitis)
33
what is now the diagnosis plan for prostate cancer and why?
MRI prior to biopsy Huge over-detection of low grade lesions that were not issues Allows for more specific detection of high grade lesions - better idea of lesion locations
34
How is the biopsy conducted for prostate cancer?
Trans perineal prostate biopsy: Systematic template biopsies of the prostate Widely used in most centres over transrectal biopsies as less risk of infection and able to sample all areas of the prostate
35
What are the TNM staging guidelines for prostate cancer? (T)
T1 – non palpable or visible on imaging T2 – palpable tumour T3 – beyond prostatic capsule into periprostatic fat T4 – tumour fixed onto adjacent structure/pelvic side wall
36
What are the TNM staging guidelines for prostate cancer? (N)
N1 – regional LN (pelvis)
37
What are the TNM staging guidelines for prostate cancer? (M)
M1a- non regional LN M1b- bone M1x- other sites
38
How is prostate cancer graded?
Gleason score Since multifocal two scores based on level of differentiation 2-6 = Well differentiated 7 = Moderately differentiated 8 – Poorly differentiated
39
How is prostate cancer treated in a young, fit person? (high and low grade)
High grade cancer - Radical prostatectomy/Radiotherapy Low grade cancer - Active surveillance ( Regular PSA, MRI and Bx) Post prostatectomy – monitor PSA ( should be undetectable or <0.01ng/ml). If >0.2ng/ml then relapse
40
Why is there hesitancy to treat low grade lesions?
risks of Erectile dysfunction | Urinary incontinence
41
How is prostate cancer treated in an old/unfit person?
high grade cancer/Metastatic disease - Hormone therapy (lower testosterone) Low grade cancer - regular PSA testing
42
What are the potential side effects of prosatectomy?
The prostate contains the proximal sphincter Prostatectomy removes this and changes urethral length. Risk of damage to cavernous nerves (innervation to bladder and urethra) Damage to cavernous nerves causes ED
43
What is cytoscopy?
Telescope examination of the bladder done under GA Can be used to take biopsies and cauterise
44
What is the difference between watchful waiting and active surveillance?
Both monitoring PSA Active surveillance for those fit for surgery Watchful waiting - palliative hormone therapy
45
how may bladder tumours be excised?
cytoscopy and transurethral resection | uses heat to cut out all visible bladder tumour - histology and curative

Year 2 Uro (5 decks)

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