Urology cancers

Question 1

Penile cancer
- Risk factors

Answer 1

HPV
- 16, 18
- 6, 8= low risk (Buschke- Lowenstein)
- HPV expression has higher survival rate

Non-circumcised

HIV

Question 2

Testicular cancer
- Types

Answer 2

Seminoma
- Pure seminoma= commonest single subtype

Non- seminoma germ cell tissue (NSGCT)- most common
- Mixed, teratoma, choriocarcinoma, yolf sac.

Question 3

Testicular cancer
- Presentation

Answer 3

Younger age (<40)

Lump felt on testicle
- Usually painful
- Hard

Haematospermia

Question 4

Testicular cancer
- Epidemiology

Answer 4

Younger age (<40)
- Mortalility is higher for older

White> Black, 5:1

Mortality is higher unmarried couples
- As well as in seminoma

Question 5

Diagnosis of testicular cancer

Answer 5

Clinical examination of testes

Imaging
- USS
- MRI

Question 6

Microlithiasis

Answer 6

Calcium clusters in testes

Question 7

Tumour markers for testicular cancer

Answer 7

AFP
- Non-seminoma

Beta-hCG
- 40-60% for NSGCT

1 or 2 markers elevated in NSGCT

30% of seminomas have elevated marker

Question 8

Pre-operative for testicular cancer

Answer 8

Sperm banking
- Especially if family hasn’t been had

Serum tumour markers

Testicular prosthesis counselling

Contralateral testis biopsy

Question 9

Radical orchiectomy
- Description
- Approach

Answer 9

Removal of testes

Approach
- Inguinal
- Incision just above inguinal ligament

Spermatic cord located and testes taken out via inguinal region

Question 10

Post-op evaluation of testicular cancer

Answer 10

Histology of tumour

Staging
- CT (Chest, abdo, pelvis)

Tumour markers

Risk stratification
- Low risk= no vascular invasion
- High risk= vascular invasion

Question 11

Treatment for NSGCT
- Low risk
- High risk

Answer 11

Low risk
- Surveillance
- Adjuvant chemo
- Nerve sparing RPLND (retroperitoneal lymph node dissection)

High risk
- Ochidectomy, chemo

Question 12

Treatment for seminoma

Answer 12

Orchidectomy

Early stage
- Adjuvant irradiation
- Surveillance

Later stage
- Adjuvant chemo

Cure rate= >99%

Question 13

Bladder cancer
- Incidence and sex

Answer 13

Incidence= 1:5000
- Trend has been increasing
- Third prevalent type of cancer

Sex= M>F 4:1

Question 14

Bladder cancer
- Presentation

Answer 14

Microscopic Haematuria
- Primary symptom
- Painless

Dysuria, urinary frequency/ urgency

Recurrent UTis

Urinary retention

Question 15

Bladder cancer
- Risk factors

Answer 15

Smoking

Genetic susceptibility
- NAT2

Amine exposure (rubber)

Iatrogenic: radiotherapy, cyclophosphamide, pioglitazone

Renal TCC

Chronic cystitis

Schistosomiasis

M>F

Older age

Question 16

Grades of bladder cancer

Answer 16

low risk
- Grade 1, 2
- Well/ moderately differentiated
- Papillary easier to visualise

High risk
- Grade 2-3
- Grade 3= poor differentiation
- Often flat, in situ.

invasive
- Mets, nodal involvement
- T2+

Question 17

Renal tumours
- Types

Answer 17

Renal Cell Carcinoma
- Most common

Transitional cell carcinoma
- 90% of lower UTI tumours but only 10% of renal tumours

Question 18

Renal cell cancer
- Risk factors

Answer 18

Smoking

obesity

HTN

Dialysis

Genetic
- Hereditary papillary RCC

Question 19

Renal Cell Carcinoma pathology

Answer 19

Adenocarcinoma

Subtypes
- Clear cell (glycogen)= most common
- Papillary
- Chromophobe
- Collecting duct (least common)

Question 20

Renal cancer mortality

Answer 20

5 year survival = 54%

Question 21

Renal cancer presentation

Answer 21

Most cases are incidental findings

Traid
- Haematuria
- Loin pain
- Loin mass

Systemic symptoms
- Anorexia, malaises, weight loss

Hypertension

metastasis: bone pain, haemoptysis, pathological fractures

Question 22

Paraneoplastic renal cancer presentation

Answer 22

Polycythaemia
- EPO

Hypercalcaemia
- PTHrP

Hypertension
- Renin

Cushing’s
- ACTH

Amyloidosis

Question 23

Renal cancer imaging

Answer 23

CT is gold standard
- Before and fater contrast

USS
- Sensitive but user-dependent

MRI for contrast allergy/ pregnancy

Question 24

Treatment of renal cancer

Answer 24

Localised
- Partial nephrectomy= laparoscopic/ robotic
- Cryo-ablation/ RFA (radiofrequency ablation)

Invasive/ large tumour
- Radical nephrectomy= laparoscopic

Question 25

Renal cancer tumour markers

Answer 25

CK7+ - More positive in chromophobe CD15+ - More positive in oncoytoma EpCAM+ - More positive in chromophobe

Question 26

Bladder cancer pathology

Answer 26

Most common - Transitional cell carcinoma/ Urothelial Squamous cell carcinoma - Associated with schistosomiasis Adenocarcinoma

Question 27

Bladder Cancer stages - Ta/ Tis - T1 - T2 - T3 - T4

Answer 27

Ta - Non-invasive papillary carcinoma Tis - Carcinoma in situ (flat tumour) T1 - Tumour invades lamina propria T2 - Invasion of mucularis propia T3 - Perivesical invasion T4 - Invasion of local tissues: i.e uterus, vagina, static stroma, pelvic/abdominal wall

Question 28

Bladder cancer - Investigations

Answer 28

Urine dip - may indicate haematuria - screen for infection Cytoscopy - Low grade tumours are easy to visualise - High grade are often flat/ in situ, so harder to visualise Urinalysis - RBC casts, crenated red cells Urine cytology - Low grade tumours often negative - High grade tumour often positive Renal and bladder USS CT abdomen and pelvis - For staging

Question 29

Bladder cancer treatment - Local - high grade - Invasive

Answer 29

Local not invaded detrusor - Complete transurethral resection - Post op chemo adjunct High risk, not invading muscle - Transurethral resection - Post op Chemo - BCG immunotherapy Muscle invasive - Neoadjuvant chemo - Cystoprostatectomy - Pelvic lymphadenopathy - Post op radiotherapy

Question 30

N staging for bladder cancer - N1, 2, 3

Answer 30

N1 - Single LN metastasis in true pelvis N2 - Muliple LN mets in true pelvis N3 - Mets in Common iliac lymph node

Question 31

Cannonball metastases in the lungs is associated with which cancer?

Answer 31

Renal cell carcinoma

Question 32

Schistosomiasis is associated with developing what malignancy?

Answer 32

Squamous cell carcinoma of the bladder

Question 33

Indications for urgent cancer referral for haematuria

Answer 33

>45 + unexplained visible haematuria without UTI or persistent UTI after treatment >60 with unexplained non-visible haematuria AND - dysuria or - Raised WCC