Urological malignancy Flashcards Preview

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Flashcards in Urological malignancy Deck (66)
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1
Q

List the benign renal tumours

A

Renal cysts
Oncocytoma
Angiomyolipoma

2
Q

Angiomyolipoma is a type of what?

A

Hamartoma (i.e normal tissue in the wrong order)

3
Q

Where is transitional cell carcinoma commonly found?

A

Bladder (less common the further up the ureter)

4
Q

How can renal cancer be investigated?

A

Ultrasound
CT (triple phase contrast)
MRI

5
Q

Everyone with chronic kidney disease gets what investigation?

A

USS

6
Q

How is renal cell cancer typically picked up?

A

Incidentally

7
Q

Are renal cysts single or multiple?

A

Can be either (more commonly single)

8
Q

What are most benign asymptomatic renal lesions?

A

Renal cysts

9
Q

How are renal cysts investigated?

A
USS
Contrast CT (define whether there's enhancement)
10
Q

Which types of tissue compose of angiomyolipoma?

A

Blood vessels
Muscles
Fat

11
Q

How is angiomyolipoma investigated?

A

CT

12
Q

What is the issue with angiomyolipoma?

A

Blood vessels are very fragile so haemorrhage risk

13
Q

What is Wunderlich’s syndrome?

A

Risk of spontaneous haemorrhage in angiomyolipoma 4-6cm causing systemic collapse due to retroperitoneal bleeding

14
Q

How are angiomyolipomas treated?

A

Embolization

15
Q

How does an oncocytoma present on CT?

A

Central scar

16
Q

How is an oncocytoma diagnosed?

A

Nephroectomy (high false negative)

17
Q

What problems does oncocytoma cause?

A

Mass effects

18
Q

Will oncocytomas metastasise?

A

No

19
Q

How does renal cell carcinoma present clinically? How are they most often picked up?

A

Classic triad is loin pain, mass, haematuria

Incidentally

20
Q

What are the paraneoplastic symptoms of renal cell carcinoma? How common are paraneoplastic syndromes in renal syndrome?

A
Weight loss
Anaemia
Hypertension
Hypercalcaemia 
Very, very common
21
Q

Which sex most commonly gets renal cell cancer?

A

Males

22
Q

Which age group most commonly get renal cell cancer?

A

65-75 y/o

23
Q

What type of cancer is renal/clear cell carcinoma?

A

Adenocarcinoma (proximal collecting tube)

24
Q

What is von hippel-lindau syndrome?

A

Familial syndrome causing multiple renal tumors

25
Q

How is renal cell cancer diagnosed?

A

USS (not diagnostic but initial investigation of mass)
CT (triple phase contrast) - diagnostic
Biopsy (high false negative phase)

26
Q

How is renal cell carcinoma staged?

A
Robson:
1 - within capsule
2 - invasion into perinephric fat
3 - involvement of regional lymph nodes +/- veins
4 - local spread or distant metastases
27
Q

Where does renal cell carcinoma most commonly metastase?

A

Lungs (common!!)
Liver
Bone
Brain (late)

28
Q

How does renal cell carcinoma commonly spread?

A

Along the veins (haematogenous)

Lymphatic

29
Q

How is renal cell carcinoma treated?

A

Nephrectomy (whole kindney & perinephric fat)
Partial nephrectomy (nephron sparing)
Radiofrequency ablation/cryoablation (

30
Q

Is adrenal gland removed in renal cell carcinoma?

A

Only if involved!

31
Q

Is there a role for adjuvant therapy in metastatic renal cell cancer?

A

Yes! (but not for non-metastatic disease!)

32
Q

What determines responsiveness to treatment in metastatic kidney disease?

A

ECOG performance status

33
Q

How do VEGF/PGEF inhibitors work? Name one

A

Limit neovascularisation

Sunitinib

34
Q

Renal cell carcinoma survival rates depend on what?

A

Robson staging

35
Q

Name two pre-malignant cutaneous lesions found on the penis? Where on the penis is each typically found?

A

Balanitis xerotica obliterans (foreskin)

Leukoplakia (glans)

36
Q

Squamous cell carcinoma of the penis can fall into which two categories?

A

In situ

Invasive

37
Q

What is another name for balanitis xerotica obliterans (BXO)?

A

Lichenus sclerosus et atrophicus

38
Q

How does balanitis xerotica obliterans present?

A

White patches
Fissuring
Bleeding
Scarring

“Tight non-retracting foreskin with white demarcated line”

39
Q

Where does BXO present?

A

Penis specifically foreskin –> glans –> urethra

40
Q

How is BXO treated?

A

Circumcision
Dilation of external meatus
Glans resurfacing

41
Q

What is squamous cell carcinoma in situ (in the penis) called?

A

Erythroplasia of Queyrat (glans, foreskin, shaft)

Bowen’s disease (other genital areas)

42
Q

How does SCC in situ on the penis present?

A

Red velvety patches

43
Q

How is SCC in situ treated?

A

Circumcision

Topical 5-FU

44
Q

What must SCC in situ on the penis be differentiated from?

A

Zoon’s balanitis (simple inflammatory condition)

45
Q

How does invasive SCC on the penis present?

A
Older men
Raised red area
Fungating mass
Foul smelling
Phimosis
46
Q

Does invasive SCC on the penis present early or late?

A

Late - reluctant to tell others

47
Q

How does phimosis predispose to SCC on the penis?

A

Poor lifelong hygiene

48
Q

How is invasive SCC of the penis diagnosed?

A
Biopsy
USS
MRI
Sentinel node biopsy 
CT (metastases)
Bone scan (symptomatic)
49
Q

Which age group typically gets SCC in the penis?

A

Over 80 y/o

50
Q

What is associated with SCC of the penis?

A

HPV 16

51
Q

How is SCC of the penis treated?

A

Surgery
Inguinal lymphadenectomy
Radiotherapy

52
Q

Describe the surgical options for treatment of SCC of the penis

A

Total penectomy
Partial penectomy
+/- reconstruction

53
Q

Metastatic SCC is treated how?

A

Surgery

Combined radio and chemotherapy

54
Q

How are testicular tumours diagnosed?

A

Examination
USS (sensitive)
Markers

55
Q

How are testicular tumours treated?

A

Orchidectomy

56
Q

What are the different types of germ cell tumours of the testis?

A

Seminoma (potato)
Teratoma
Intratubular germ cell neoplasia (pre-malignant)

57
Q

How do testicular tumours present?

A

Painless
Non-tender
Hard swelling

58
Q

What investigations are used to stage testicular tumours?

A

CXR (canon ball metastases)

CT abdomen/thorax

59
Q

Which markers are useful in the diagnosis of testicular cancer? What else are they useful for?

A

AFP (NOT seminoma)
HCG (variable mostly teratoma)
LDH (tumour burden)

Monitoring response to treatment

60
Q

Orchidectomy is an inguinal operation. T/F

A

True - do NOT go in through scrotum

61
Q

What MUST be done during an orchidectomy?

A

Clamping of vessels before removal of testis (prevent spread of tumour)

62
Q

Who gets testicular tumours?

A

20-30 y/o (varies between different tumour types)

63
Q

What increases risk of testicular cancer?

A

Undescended testis

64
Q

List the different types of teratoma

A

Differentiated
Undifferentiated
Intermediate
Trophoblastic (elevated HCG)

65
Q

How are testicular tumours staged?

A

TNM S (s for markers)

66
Q

How are testicular tumours managed?

A

Seminoma - radiotherapy

Teratoma - chemotherapy

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