Urological malignancies Flashcards Preview

Renal and urology > Urological malignancies > Flashcards

Flashcards in Urological malignancies Deck (64):
1

Where is the most common site for a transitional cell carcinoma and how does this present?

Trigone

Ureteric obstruction

2

What are some pre-malignant lesions that might indicate penile cancer?

—Balanitis xerotica obliterans

Leukoplakia
 

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3

What is balanitis xerotica obliterans?

—Lichenus sclerosis and atrophy

White patches, fissuring, bleeding. scarring
 

4

What is the name given to squamous carcinoma-in-situ if it is located on the glans, prepuce or shaft of the penis?

Erythroplasia of Queyrat
 

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5

What are the treatments avaliable for —Erythroplasia of Queyrat or Bowen's disease?

—Circumcision (—if prepuce alone)

Topical 5 fluorouracil 
 

6

How does invasive squamous cell carcinoma of the penis present?

—Red raised area penis
—Fungating mass, foul smelling
—Phimosis

Presentation delayed in up to 50% of cases
 

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7

What is phimosis?

A condition of the penis where the foreskin cannot be fully retracted over the glans penis

8

How is carcinoma of the penis treated?

Surgery

Inguinal Nodes:
—Prognosis, treatment options
—Imaging, radionuclide sentinal node biopsy
—Inguinal lymphadenectomy

—Radiotherapy
 

9

What are some examples of germ-cell testicular tumour?

Seminoma

Teratoma

Embryonal

Yolk sac

Choriocarcinoma

—Intra-tubular germ cell neoplasia (ITGCN)


 

10

What is the presentation of testicular tumours?

Painless, insensitive testicular swelling

11

How do metastatsis from testicular tumours present?

Neck nodes

Dyspneoa

12

What imaging is done in testicular tumours?

Ultrasound scanning

Also CXR, CT Abdomen/Thorax for staging
 

13

Which serum marker would indicate seminoma?

PLAP - placental alkaline phosphatase

 

14

Which serum marker is never raised in pure seminoma?

AFP - alpha fetoprotein

15

When might AFP be raised?

Hepatocellular carcinoma

Nonseminomatous germ cell tumors of the ovary and testis (eg, yolk sac and embryonal carcinoma)

16

When might HCG (human chorionic gonadotrophin) be raised?

In 5-10% of pure seminomas

Teratomas

17

Why are LDH levels measured with testicular tumours?

To assess tumour burden

18

How does seminoma spread usually?

Via lymphatics

19

What is a seminoma?

A germ-cell tumour of the testicle

20

Which lymph nodes become swollen with seminoma?

Para-aortic 
Due to where testicles originally descend from

21

What is orchidectomy?

A procedure where one or both of the testicles are removed

22

What increases the risk of development of testicular tumour?

Undescended testicle

23

Which serum marker becomes raised with teratoma?

HCG

24

What is the verumontanum?

An elevation in the floor of the prostatic portion of the urethra where the seminal ducts enter

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25

Which area of the prostate gives rise to BPH?

The transitional zone

26

Where is the transitonal zone of the prostate?

Surrounds the prostatic urethra proximal to the Veru

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27

Where is the central zone of the prostate?

Cone shaped region that surround the ejaculatory ducts 

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28

Where is the peripheral zone of the prostate?

Posteriolateral prostate - this is the majority of prostatic tissue

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29

Where is the origin of most prostate adenocarcinoma?

Peripheral zone

30

What is the peak age of developing a prostate cancer?

70-74

31

How does prostate cancer present?

Urinary frequency

Difficulty finishing

Nocturia 

Haematuria

Bone pain

Anorexia

Weight loss

32

What abnormalities may be felt on PR exam in prostatic cancer?

Assymetry

Enlarged prostate

Nodule

Craggy

33

What is prostate specific antigen?

A glycoprotein (kallikrein-like serine protease) enzyme produced by the secretory epithelial cells of the prostate gland that is involved in the liquefication of semen

 

34

What things can raise a PSA?

Carcinoma of the prostate

Benign prostatic hyperplasia

Prostate drugs (alpha-blockers)

Riding bikes etc

Prostatitis / UTI’s

       Retention

       Catheterization

       DRE

35

What investigations can be done following a raised PSA result?

Trans-rectal ultrasound biopsy

36

What are the disadvantages of a trans-rectal ultrasound biopsy?

Uncomfortable

     1% risk of significant sepsis and bleeding

     May need repeat biopsy

37

When is a trans-rectal ultrasound biopsy indicated?

Men with an abnormal DRE, an elevated PSA

Previous normal biopsies but rising PSA trends

Previous biopsies showing prostatic interepithelial neoplasia or atypical small acinar proliferation

 

38

How is a sample obtained in trans-rectal ultrasound guided prostate biopsy?

Ultrasound probe passed through the rectum and prostate visualised in sagittal and transverse sections

5 biopsies taken from each lobe

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39

What kind of cancer are most prostate cancers?

Multifocal adenocarcinomas

40

Where are the most common sites of metastasis from a prostate lesion?

Pelvic lymph nodes

Skeleton

41

What is characterstic of the bone metastasis from the prostate?

Sclerotic lesions

42

What scoring system is used to grade prostate cancers?

Gleason's 

43

What is unique about Gleason's scoring system?

Gives a score based on the architectural appearance of the prostate glands rather than cytological features

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44

How is Gleason's score calculated?

Microscopically,CaP is graded from 1 to 5

The initial feature of malignancy is loss of the basement membrane and the Gleason score increases with loss of the glandular structure and replacement by a disorganised malignant cell growth pattern.

The two most abundant cell patterns are assessed and then added together to give a score between 2 to 10

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45

Why is Gleasons score widely used to grade prostate carcinoma?

Gives a very good indication of prognosis

46

What imaging is used for TNM staging of prostate cancer?

MRI
Bone scan

CT

47

At which TNM staging is prostate cancer no longer confined to the prostate?

T3-4: at T3, it invades past the prostate capsule

48

What is the difference between watchful waiting/deferred treatment and active surveillance?

Watchful waiting is conservative management until local or systemic involvement which is then followed by palliative care

Active surveillance follows the patient until they reach a certain threshold e.g. degeneration on biopsy, followed by curative treatment

49

What surgical option is avaliable for prostate cancer?

Radical prostatectomy (open, laprascopic or robotic)

50

What are the complications associated with radical prostatectomy?

Erectile dysfunction

Bladder neck stenosis

Incontinence

51

What non-surgical treatment is there for prostatic cancer?

External-beam radiotherapy

Brachytherapy (internal radiotherapy)

 

52

What complications can arise from radiotherapy of the prostate?

Irritative lower urinary tract symptoms

Haematuria

GI symptoms

Erectile Dysfunction

Incontinence

53

What is the ideal treatment for locally invasive prostatic cancer?

Radiotherapy with neo-adjuvant hormonal therapy
 

54

For which patients is watchful waiting the ideal management of locally invasive prostatic cancer?

Asymptomatic patients with well and moderately differentiated tumours and a life expectancy < 10 years

    Patients who do not accept treatment-related complications

55

In which patients is hormonal therapy the ideal treatment for prostatic carcinoma?

Symptomatic patients, who need palliation of symptoms, unfit for curative treatment

56

How is metastatic prostatic cancer treated?

Androgen Deprivation therapy:

Hormonal therapy (LHRH analogues and anti-androgens)

   Bilateral Subcapsular Orchidectomy

   Maximal Androgen blockade

Diethylstilbesterol/ Steroids

Cytotoxic chemotherapy

57

Why is androgen blockade used to treat prostatic cancer?

Prostate cell growth is under control of testosterone

Testosterone release is inhibited by circulating androgen, due to the negative feedback mechanism

If prostate cells are deprived of androgenic stimulation, they undergo apoptosis 

58

What is the 'testosterone surge' or 'flare up' phenomenon associated with LHRH analogues

LHRH analogues initially stimulate pituitary LHRH receptors, inducing a transient rise in LH and FSH release, and consequently elevate testosterone production

      20% of patients manifest with catastrophic spinal cord compression

59

How is the flare up or testosterone surge phenomenon associated with prostate cancer prevented?

To prevent this anti-androgen is given for cover 1 week before and 2 weeks after the first dose of LHRH injection

60

What are the side effects of LHRH antagonists?

Loss of libido

      Hot flushes and sweats

      Weight gain

      Gynaecomastia

      Anaemia

      Cognitive changes

      Osteoporosis

61

How do anti-androgens have effect against prostate cancer?

Anti-androgens compete with testosterone and DHT for binding sites on their receptors in the prostate cell nucleus, thus promoting apoptosis and inhibiting CaP growth
 

62

What types of anti-androgen are there?

Steroidal: cyproterone acetate

Non-steroidal: nilutamide, flutamide and bicalutamide

63

What are the side effects of steroidal anti-androgens?

Loss of libido and erectile dysfunction

Gynaecomastia (rare)

Cardiovascular toxicity

Hepatotoxicity

64

What are the side effects of non-steroidal anti-androgens?

Gynaecomastia

Breast pain

Hot flashes

Hepatotoxicity