Urological Malignancy Flashcards by Aliya Hussain

Types of renal tumours?

Malignant:
• Renal cell carcinoma

Benign:
• Oncocytoma
• Angiomyolipomas

How well did you know this?

Not at all

Perfectly

Types of penile cancer?

SCC

Carcinoma-in-situ

How well did you know this?

Not at all

Perfectly

Types of testicular cancer?

Seminoma

Teratoma

How well did you know this?

Not at all

Perfectly

Mnemonic for the pathology of urological tumours?

Incidence
• Age 
• Sex
• Geographic
• Aetiology
• Predisposing factors
• Macroscopic appearance
• Microscopic appearance
• Spread
• Prognosis

In A Surgeon’s Gown, A Physician May Make Some Progress

How well did you know this?

Not at all

Perfectly

Benign renal tumours?

Renal cysts

Oncocytoma

Angiomyolipoma

How well did you know this?

Not at all

Perfectly

Tumours of the renal pelvis?

Transitional cell carcinoma

How well did you know this?

Not at all

Perfectly

Tumours of the renal parenchyma?

Renal cell carcinoma

How well did you know this?

Not at all

Perfectly

Embryonic renal tumours?

Nephroblastoma (Wilm’s tumour)

How well did you know this?

Not at all

Perfectly

Radiological tests for renal tumours?

USS - can differentiate between cysts and solid material

CT scan

MRI scan - can differentiate between tumours and haemorrhage

How well did you know this?

Not at all

Perfectly

Occurrence of benign renal cysts?

Comprise 70% of benign asymptomatic renal lesions; typically an incidental finding

Can be single OR multiple

How well did you know this?

Not at all

Perfectly

Imaging for benign renal cysts?

USS and contrast CT scan (can identify if they are simple cysts and whether there is an associated risk, e.g: haemorrhage)

How well did you know this?

Not at all

Perfectly

What are angiomyolipomas?

Benign tumours of blood vessels, fat and muscles

How well did you know this?

Not at all

Perfectly

Imaging for angiomyolipomas?

CT scan - hounsfield unit thresholds are used to identify an angiomyolipoma (if <10, there is fat)

How well did you know this?

Not at all

Perfectly

Complications of angiomyolipomas?

Wunderlich syndrome - spontaneous, non-traumatic renal hemorrhage confined to the subcapsular and perirenal space; it may be 1st presentation of an angiomyolipoma that is ≥6cm in size

How well did you know this?

Not at all

Perfectly

Treatment of Wunderlich syndrome?

Embolisation

How well did you know this?

Not at all

Perfectly

Occurrence of oncocytoma?

<10% of renal masses

Some RCCs prove to be an oncocytoma

How well did you know this?

Not at all

Perfectly

What are oncocytomas?

Often a benign tumour of oncocytes (epithelial cells characterized by an excessive amount of mitochondria)

How well did you know this?

Not at all

Perfectly

Imaging of oncocytomas?

CT scan - central, stellate scar

How well did you know this?

Not at all

Perfectly

Definitive diagnosis of oncocytoma?

There is a high false -ve rate at biopsy (as unable to biopsy the entire lesion)

No definitive diagnosis except at NEPHRECTOMY

How well did you know this?

Not at all

Perfectly

Classic triad of renal cell carcinomas presentation?

Only present in 15%:
• Loin pain
• Renal mass
• Haematuria

How well did you know this?

Not at all

Perfectly

Other presentations of renal cell carcinomas?

Study These Flashcards

Incidental on imaging

```
Paraneoplastic syndrome, e.g:
• Weight loss
• Anaemia
• Polycythaemia
erythropoietin
• Hypercalcaemia (PTH)
~~~

Occurrence of renal cell carcinoma?

Study These Flashcards

More common in male (2:1)

Peak incidence at 65-75 years

If multifocal or bilateral, consider VON-HIPPEL LINDAU

Types of renal cell carcinoma?

Study These Flashcards

Adenocarcinoma of PCT

Clear cell

Papillary

Diagnosis of renal cell carcinoma?

Study These Flashcards

USS and CT scan

Biopsy (there is a high false -ve rate in RCC)

Staging systems for RCC?

Robson TNM staging

Metastases from RCC can occur to which areas?

LUNGS, liver, bone and brain

Surgical options for RCC?

Radical nephrectomy -removes the whole kidney within Gerota's fascia and removes the perinephric fat Partial nephrectomy (nephron sparing) Radiofrequency ablation, cryoablation (if small enough)

Adjuvant therapy available for RCC?

IL-2 (interleukin-2) INF-α VEGF/PDGF inhibitors (e.g: Sunitinib) - reduce neovascularisation

Measurements available to check the consequences of metastatic disease on the patient's life?

ECOG performance status - assess how disease is progressing, affects ADLs and determine appropriate treatment and prognosis

Classifications of penile cancer?

Pre-malignant cutaneous lesions: • Balanitis xerotica obliterans • Leukoplakia SCC: • Carcinoma-in-situ • Invasive SCC

What is balanitis xerotica obliterans?

AKA lichenus sclerosus et atrophicus Affects the prepure and/or glans penis and there may be urethral extension

Treatment of balanitis xerotica obliterans?

Circumcision If meatal stenosis has occurred, this requires dilatation May require glans resurfacing

Consequences of balanitis xerotica obliterans?

Phimosis is a common consequence

Types of carcinoma-in-situ of the penis?

If affecting the glans, prepuce or shaft of the penis: • Erythroplasia of Queyrat If affecting the remainder of the genitalia: • Bowen's disease

Presentation of squamous carcinoma-in-situ of the penis?

Red, velvety patches

Treatment of squamous carcinoma-in-situ of the penis?

If prepuce alone is affected, circumcision Topical 5 fluorouracil

Presentation of invasive SCC of the penis?

``` Often delayed presentation with: • Red, raised area on the penis • Fungating mass • Foul-smelling discharge • Phimosis ```

Occurrence of SCC of the penis?

Peak incidence at 80 years of age May be assoc. with HPV type 16 (risk factor) Circumcision during infancy/childhood MAY provide partial protection against penile cancer, but this is not the case when performed in adulthood

Staging of penile carcinoma?

TNM staging

Treatment of carcinoma of the penis?

Surgery Inguinal nodes (influence prognosis and treatment): • Imaging, radionuclide sentinel node biopsy • Inguinal lymphadenectomy Radiotherapy

Surgical options of penile carcinoma?

Total/partial penectomy Reconstruction Inguinal lymph node sentinel biopsy

Classifications of testicular tumours?

Germ cell tumours are: • Seminoma • Non-seminomatous germ cell tumours (teratoma, embryonal, yolk sac, choriocarcinoma) • ITGCN (Intratubular Germ Cell Neoplasia) Secondary tumours: • Lymphoma • Leukaemia • Metastatic spread from elsewhere

Presentation of testicular tumours?

Painless, insensitive testicular tumours 10% present due to metastases: • Swollen neck lymph nodes • Dyspnoea

Diagnosis of testicular tumours?

USS scan (1st line) CXR, CT abdomen/thorax (for staging) Tumour markers: • α-fetoprotein (AFP) • Human chorionic gonadotrophin (HCG) • Lactate dehydrogenase (LDH)

Testicular tumours where the different tumours markers are raised?

Never raised in a pure seminoma HCG is raised in: • 5-10% of pure seminoma • Up 10 60% of teratoma LDH - measure of tumour burden (volume)

Surgical treatment of testicular tumours?

Orchidectomy with high ligation of cord Prosthesis (patient choice)

Cautions with testicular tumour diagnosis and treatment?

May do a biopsy of the contralateral testicle (risk of ITGCN)

Occurrence of testicular tumours?

Peak incidence 2-35 year old 30 x increased risk with undescended testicles Some cases of bilateral (simultaneously or successively)

Pathology of teratoma?

``` Can be: • Differentiated • Intermediate • Undifferentiated • Trophoblastic (THESE ALL HAVE ELEVATED HCG) ```

Staging of testicular tumours?

TNM staging AJCC staging

Residual mass location with testicular tumours?

May require Retroperitoneal Lymph Node Dissection (RPLND) as residual masses may harbour a tumour; these are that: • 1/3rd fibrous tissue only • 1/3rd mature teratoma (benign) • 1/3rd residual tumours

Urological Malignancy Flashcards

(51 cards)