Urological malignancy

Question 1

List the benign renal tumours

Answer 1

Renal cysts
Oncocytoma
Angiomyolipoma

Question 2

Angiomyolipoma is a type of what?

Answer 2

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

Question 3

Where is transitional cell carcinoma commonly found?

Answer 3

Bladder (less common the further up the ureter)

Question 4

How can renal cancer be investigated?

Answer 4

Ultrasound
CT (triple phase contrast)
MRI

Question 5

Everyone with chronic kidney disease gets what investigation?

Answer 5

USS

Question 6

How is renal cell cancer typically picked up?

Answer 6

Incidentally

Question 7

Are renal cysts single or multiple?

Answer 7

Can be either (more commonly single)

Question 8

What are most benign asymptomatic renal lesions?

Answer 8

Renal cysts

Question 9

How are renal cysts investigated?

Answer 9

USS
Contrast CT (define whether there's enhancement)

Question 10

Which types of tissue compose of angiomyolipoma?

Answer 10

Blood vessels
Muscles
Fat

Question 11

How is angiomyolipoma investigated?

Answer 11

CT

Question 12

What is the issue with angiomyolipoma?

Answer 12

Blood vessels are very fragile so haemorrhage risk

Question 13

What is Wunderlich’s syndrome?

Answer 13

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

Question 14

How are angiomyolipomas treated?

Answer 14

Embolization

Question 15

How does an oncocytoma present on CT?

Answer 15

Central scar

Question 16

How is an oncocytoma diagnosed?

Answer 16

Nephroectomy (high false negative)

Question 17

What problems does oncocytoma cause?

Answer 17

Mass effects

Question 18

Will oncocytomas metastasise?

Answer 18

No

Question 19

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

Answer 19

Classic triad is loin pain, mass, haematuria

Incidentally

Question 20

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

Answer 20

Weight loss
Anaemia
Hypertension
Hypercalcaemia 
Very, very common

Question 21

Which sex most commonly gets renal cell cancer?

Answer 21

Males

Question 22

Which age group most commonly get renal cell cancer?

Answer 22

65-75 y/o

Question 23

What type of cancer is renal/clear cell carcinoma?

Answer 23

Adenocarcinoma (proximal collecting tube)

Question 24

What is von hippel-lindau syndrome?

Answer 24

Familial syndrome causing multiple renal tumors

Question 25

How is renal cell cancer diagnosed?

Answer 25

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

Question 26

How is renal cell carcinoma staged?

Answer 26

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

Question 27

Where does renal cell carcinoma most commonly metastase?

Answer 27

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

Question 28

How does renal cell carcinoma commonly spread?

Answer 28

Along the veins (haematogenous) | Lymphatic

Question 29

How is renal cell carcinoma treated?

Answer 29

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

Question 30

Is adrenal gland removed in renal cell carcinoma?

Answer 30

Only if involved!

Question 31

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

Answer 31

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

Question 32

What determines responsiveness to treatment in metastatic kidney disease?

Answer 32

ECOG performance status

Question 33

How do VEGF/PGEF inhibitors work? Name one

Answer 33

Limit neovascularisation | Sunitinib

Question 34

Renal cell carcinoma survival rates depend on what?

Answer 34

Robson staging

Question 35

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

Answer 35

Balanitis xerotica obliterans (foreskin) | Leukoplakia (glans)

Question 36

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

Answer 36

In situ | Invasive

Question 37

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

Answer 37

Lichenus sclerosus et atrophicus

Question 38

How does balanitis xerotica obliterans present?

Answer 38

White patches Fissuring Bleeding Scarring "Tight non-retracting foreskin with white demarcated line"

Question 39

Where does BXO present?

Answer 39

Penis specifically foreskin --> glans --> urethra

Question 40

How is BXO treated?

Answer 40

Circumcision Dilation of external meatus Glans resurfacing

Question 41

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

Answer 41

Erythroplasia of Queyrat (glans, foreskin, shaft) | Bowen's disease (other genital areas)

Question 42

How does SCC in situ on the penis present?

Answer 42

Red velvety patches

Question 43

How is SCC in situ treated?

Answer 43

Circumcision | Topical 5-FU

Question 44

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

Answer 44

Zoon's balanitis (simple inflammatory condition)

Question 45

How does invasive SCC on the penis present?

Answer 45

``` Older men Raised red area Fungating mass Foul smelling Phimosis ```

Question 46

Does invasive SCC on the penis present early or late?

Answer 46

Late - reluctant to tell others

Question 47

How does phimosis predispose to SCC on the penis?

Answer 47

Poor lifelong hygiene

Question 48

How is invasive SCC of the penis diagnosed?

Answer 48

``` Biopsy USS MRI Sentinel node biopsy CT (metastases) Bone scan (symptomatic) ```

Question 49

Which age group typically gets SCC in the penis?

Answer 49

Over 80 y/o

Question 50

What is associated with SCC of the penis?

Answer 50

HPV 16

Question 51

How is SCC of the penis treated?

Answer 51

Surgery Inguinal lymphadenectomy Radiotherapy

Question 52

Describe the surgical options for treatment of SCC of the penis

Answer 52

Total penectomy Partial penectomy +/- reconstruction

Question 53

Metastatic SCC is treated how?

Answer 53

Surgery | Combined radio and chemotherapy

Question 54

How are testicular tumours diagnosed?

Answer 54

Examination USS (sensitive) Markers

Question 55

How are testicular tumours treated?

Answer 55

Orchidectomy

Question 56

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

Answer 56

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

Question 57

How do testicular tumours present?

Answer 57

Painless Non-tender Hard swelling

Question 58

What investigations are used to stage testicular tumours?

Answer 58

CXR (canon ball metastases) | CT abdomen/thorax

Question 59

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

Answer 59

AFP (NOT seminoma) HCG (variable mostly teratoma) LDH (tumour burden) Monitoring response to treatment

Question 60

Orchidectomy is an inguinal operation. T/F

Answer 60

True - do NOT go in through scrotum

Question 61

What MUST be done during an orchidectomy?

Answer 61

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

Question 62

Who gets testicular tumours?

Answer 62

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

Question 63

What increases risk of testicular cancer?

Answer 63

Undescended testis

Question 64

List the different types of teratoma

Answer 64

Differentiated Undifferentiated Intermediate Trophoblastic (elevated HCG)

Question 65

How are testicular tumours staged?

Answer 65

TNM S (s for markers)

Question 66

How are testicular tumours managed?

Answer 66

Seminoma - radiotherapy | Teratoma - chemotherapy