Urological Malignancy

Question 1

Is the incidence of bladder carcinoma increasing or decreasing?

Answer 1

Decreasing

Question 2

Who is more likely to get bladder cancer? Males or females?

Answer 2

Males

Question 3

What ethnicity is at a higher risk of bladder cancer?

Answer 3

White

Question 4

What risk factors are there for bladder cancer?

Answer 4

Smoking- 4* risk
Occupational exposure (up to 20 years latent period):
Rubber or plastics manafacture, handling of carbon, crude oil, combustion, painters, mechanics, printers, hairdressers

Question 5

What is the histology of bladder cancer?

Answer 5

Transitional cell carcinoma

20% are squamous cell carcinoma

Question 6

What are the risk factors for developing squamous cell carcinoma of the bladder>

Answer 6

Long term catheters, recurrent UTIs, bladder stones

Schistosomiasis in endemic areas

Question 7

What are the treatment options for bladder cancer?

Answer 7

Initial assessment- TURBT- transurethral resection, allows assessment of histological type, grade and stage. If tumour is superficial, a single dose of intravesical mytomycin is given

Low risk, non muscle invasive- check cystoscopies
Intermediate/ high risk-intravesicular chemotherapy/ BCG
Muscle invasive- either neoadjuvant chmmo and radical cystectomy with formation of ileal conduit or palliative chemo

Metastatic- palliative systemic chemotherapy or biological therapies- PDL1 inhibitors

Question 8

What percentage of upper urinary tract tumours does Renal cell carcinoma make up?

Answer 8

95%

Question 9

Is the incidence of renal cell carcinomas increasing or decreasing?

Answer 9

Increasing

Question 10

Who is most likely to get renal cell carcinoma?

Answer 10

White males

Question 11

What are the risk factors for renal cell carcinoma?

Answer 11

Heavy smoking, obesity, positive family history

Question 12

What is the histology of renal cell carcinoma?

Answer 12

Its an adenocarcinoma, can be either clear cell- commonest, papillary, chromophobe, collecting duct (Von hippel Lindau) or medullary- sickle cell anaemia

Question 13

What percentage of patients have mets on presentation with renal cell carcinoma?

Answer 13

30%

Question 14

How does renal cell carcinoma present?

Answer 14

Haematuria
Incidental finding
Palpable mass- rare

Question 15

What are the treatment options for renal cell carcinoma?

Answer 15

ablation, surveillance, partial nephrectomy, radical nephrectomy
Tyrosine kinase inhibitors can be given if metastatic

Question 16

How might upper urinary tract TCC present?

Answer 16

Visible haematuria

Question 17

What investigations might be required for upper urinary tract TCC/

Answer 17

CT urogram, ureteroscopy +- biopsy

Question 18

What is the standard treatment for upper urinary tract TCC?

Answer 18

Small, low grade- laser ablation

Most- nephro ureterectomy- kidney, fat, ureter and cuff of bladder

Question 19

What is the common age range for testicular cancer?

Answer 19

15-45

Question 20

What is one of the main risk factors for testicular cancer?

Answer 20

Undescended testes

Question 21

What types of testicular cancer are there?

Answer 21

Leydig cell tumours - klinefelters syndrome
Germ cell tumours- can be seminoma or teratoma
Lymphoma (older men)

Question 22

How does testicular cancer present?

Answer 22

Lump- solid mass, inseperable from testis on clinical examination
Systemic sx if mets

Question 23

How are testicular cancers diagnosed?

Answer 23

USS- biopsy if necessary

Question 24

What tumour markers are available for testicular cancer?

Answer 24

Alpha fetoprotein- specific to non seminomatous testicular cancer

Beta HCG- raised in NSGCT

LDH- marker of tumour bulk

Question 25

What are the treatment options for testicular cancer?

Answer 25

Inguinal orchidectomy Adjuvant chemo if high volume mets, sometimes use retroperitoneal lymph node dissection for residual NSGCT masses after chemo Radiotherapy used in seminoma Sperm banking is offered to all under 55

Question 26

What percentage of penile cancers present under 50 years old?

Answer 26

20%

Question 27

What clinical features might lead you to suspect penile cancer>?

Answer 27

Persistent lump despite treatment and exclusion of STI

Question 28

What are the risk factors for penile cacner?

Answer 28

HPV 16+18 infection | Phimosis, poor hygiene, smegma build up

Question 29

What histological tissue type are penile cancers?

Answer 29

Squamous cell carcinoma

Question 30

What is the prognosis for penile cancer?

Answer 30

If untreated most die within 2 years. All die within 5.