Urological Malignancy

Question 1

How can benign renal cysts be imaged?

Answer 1

USS

(maybe contrast CT)

Question 2

Which symptoms are caused by benign renal cysts?

Answer 2

Generally no symptoms

(very common incidence 1:10)

Question 3

What is an angiomyolipoma?

Answer 3

A benign process involving a disproportionate amount of blood vessels, fat and muscle

Question 4

How can an angiomyolipoma be imaged?

Answer 4

CT

Question 5

What is the main risk of angiomyolipoma?

Answer 5

Haemorrhage and sudden cardiovascular collapse

Question 6

How is angiomyolipoma treated?

Answer 6

Embolisation if large

(prevents bursting and blood loss)

Question 7

What is an oncocytoma?

Answer 7

A benign renal tumour

Question 8

What is the characteristic appearance of an oncocytoma?

Answer 8

Central scar on CT

Question 9

Why does an oncocytoma develop a central scar?

Answer 9

Not malignant so does not possess angiogenic potential

Centre necroses and scars

Question 10

How can oncocytoma be diagnosed?

Answer 10

Only at total nephrectomy

Biopy or 99m-Tc-Sestamibi SPECT-CT can indicate

Question 11

What is the classic triad of symptoms for a renal tumour?

Answer 11

1. Loin pain
2. Renal mass
3. Haematuria

Vast majority are picked up incidentally before the classic triad appears

Question 12

What are the main paraneoplastic symptoms of renal cell carcinoma?

Answer 12

Weight loss

Anaemia

Hypercalcaemia (produces parathyroid like peptide)

Hypertension

Question 13

What is the peak incidence for renal cell carcinoma?

Answer 13

65-75

Question 14

What is a renal cell carcinoma?

Answer 14

Adenocarcinoma of proximal convoluted tubule

Question 15

In patient who has multifocal renal cell carcinoma or bilateral tumour, what may be the cause?

Answer 15

Von hippel-Lindau

Question 16

How can renal cell carcinoma be diagnosed?

Answer 16

USS

Triple phase CT

Percutaneous biopsy

Nephrectomy

Question 17

Renal cell carcinomas are contrast ___________

Answer 17

Renal cell carcinomas are contrast enhancing

Question 18

What is the staging system used for rena cell carcinoma?

Answer 18

Robson staging

(or TNM)

Question 19

Where do renal cell carcinomas commonly metastasize?

Answer 19

Lungs (most common)

Liver

Bone

Brain

Question 20

What is the standard surgery for renal cell carcinoma?

Answer 20

Laparoscopic nephrectomy

Question 21

What is not removed routinely in a laparoscopic nephrectomy?

Answer 21

Adrenal gland(s)

Question 22

What is the idea behind partial nephrectomy?

Answer 22

Nephron sparing

Prevents unnecessary drop in GFR

Question 23

In patients with small masses, or those where the kidneys cannot be removed, what treatment options are there for renal cell carcinoma?

Answer 23

Radiofrequency ablation

Cryotherapy

Question 24

How are small renal masses diagnosed?

Answer 24

Almost always by incidental imaging

Question 25

How are small renal masses generally treated?

Answer 25

**Biopsy first** Benign - Monitor Malignant: 1. Minimally invasive ablation 2. Partial nephrectomy

Question 26

What do tyrosine kinase inhibitors do for renal cell carcinomas?

Answer 26

Inhibit angiogenesis pathway

Question 27

What precancerous lesion on the foreskin has white oatches, fissuring, bleeding and scarring

Answer 27

Balantitis xerotica obliterans

Question 28

What should be done for BXO?

Answer 28

Circumcision | (unless spread further)

Question 29

Carcinoma of the penis is related to which virus?

Answer 29

HPV (type 16)

Question 30

Where does carcinoma of the penis spread?

Answer 30

Inguinal nodes

Question 31

What are the treatment options for penile carcinoma?

Answer 31

Surgery Radiotherapy and chemotherapy Inguinal lymphadenopathy (prevents potential for spread)

Question 32

What are the most common germ cell tumours of the testes?

Answer 32

Seminoma Non-seminomatous

Question 33

How do testicular tumours present?

Answer 33

Painless swelling

Question 34

Which imaging test is the gold standard for testicular tumours?

Answer 34

USS (Staging for CT, CXR in case of metastasis)

Question 35

What are the different markers for testicular cancer?

Answer 35

AFP HCG LDH

Question 36

In pure seminoma, which marker is never raised?

Answer 36

AFP

Question 37

\*What are the types of non-seminomatous testicular cancers?

Question 38

Where can testicular cancers spread?

Answer 38

Lumbar nodes