Urology Path (1/2 GU) Flashcards by Nóra Monaghan

Breakdown % of bladder and ureteric tumours

84%: TCC

10%: Squamous ca

5%: Adenocarcinoma

1%: Misc

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What type of epithelium lines the bladder and ureter?

Transition cell epithelium

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What infection is associated with Squamous ca?

Schistosomiasis

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How invasive is TCC of bladder/ureter?

Often the first tumour is not invasive
But it often recurs
When the tumour recurs it is more invasive

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RF for Bladder/Ureter tumours?

Smoking

Aniline dye exposure (Rubber industry)

Hydrocarbon exposure

Males

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Presentation of Bladder/Ureteric tumours

Lower urinary tract sx (LUTs)
Haematuria (may be micro)
Palpable mass (Rare)

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Investigations Bladder/Ureteric tumours

Cystoscopy + Biopsy/ Transurethral resection

IVUrogram

MRI

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Dx this:

Red lesions see on cystoscopy

Transitional cell Carcinoma in sitiu

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Dx this:

Polypoid lesions on cystoscopy

Superficial TCC

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Dx this:

Pale , flat, ulcerated and necrotising lesion on cystoscopy

Invasive Transitional cell carcinoma

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What embryonic abnormality is bladder adenocarcinoma associated with?

Urachus

Stump that should’ve formed the median umbilical ligament

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Where are bladder adenocarcinomas located?

Dome of bladder

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Histology of bladder adenocarcinoma

Papillary and Glandular tumours

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Staging of bladder/ureteric tumours

pTa: non-invasive

pT1: Submucosal invasion

pT2: Muscularis propria invasion

pT3: Invasion beyond Muscularis propria

pT4: Spread to adjacent organs

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Management of Bladder cancer

Surgery
- TURBT (tumour resection) in low risk
- Cystectomy + ileal conduit (Stoma) if T2+
Oncology
- BCG
- +/-Chemoradio

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Complication of bladder carcinoma in sitiu

Often TCC present also

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Rx bladder ca in sitiu

BCG

+ Surgery if TCC also present

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Complications of ureteric TCC

Often bilateral/multifocal

Often occur alongside TCC bladder

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What are the 4 malignant tumours of the penis?

Squamous cell ca

Malignant melanoma (rare)

Spindle cell ca

Adenosquamous ca

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RF for penile cancers

Poor hygiene

Uncircumcised

HPV

Smoking

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Pre-neoplastic penile conditions

Bowenoid papulosis

Erythroplasia de Queyrat

Bowens disease

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Cause of Bowenoid Papulosis

HPV

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Presentation of Bowenoid Papulosis

Red/Brown spots on skin of genitals

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Epi of Bowenoid Papulosis

Young sexually active males

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Epi of Erythroplasia de Queyrat

Elderly males

What is Erythroplasia de Queyrat?

CIS of foreskin (Glans Penis)

What is Bowens disease?

Dysplasia of skin

Non-Neoplastic Testicular Diseases 3

Epididymo-orchitis Torsion Hydrocoele

Non-neoplastic testicular emergency

Torsion Need intervention within 24hrs

Cause of Epididymo-orchitis

Infalmmation following UTI or STI

Pathogenesis of testicular torsion

Spermatic cord twists Blood supply to the testes is cut off Will result in infarction if no intervention

Epi of Testicular torsion

Young males

Presentation of testicular torsion

Intense pain

Pathogenesis of testicular hydrocoele

Accumulation of fluid in the scrotum

Epi of testicular hydrocoele

Older males Newborns

Cause of Testicular Hydrocoele

Trauma or UTI

Treatment of testicular torsion

Surgery to untwist vessels and suture them in a way that it can recur

Epi testicular cancer

Young males

Types of testicular germ cell tumours % breakdown

Seminoma 50% Mixed germ cell 33% Non-seminomatous GCT (Teratoma) 15%

Epi of testicular seminoma

40-50 y/o

Macroscopic features of testicular seminoma

Fleshy pale

Microscopic features of testicular seminoma

- Sheets of large cells - Lymphoid stroma - No spermatogenesis in the cells near the tumour

British Testicular pannel classification of Teratomas

Malignant Teratoma: MTD: Differentiated MTI: Intermediate: MTU: Undifferentiated MTT: Trophoblastic

Types of Teratomas 5

Malignant Teratoma Embryonal ca Yolk sac Choriocarcinoma Polyembryona

Microscopic features of Embryonal ca 2

Spindle Glands

Microscopic features of Choriocarcinoma 3

Haemorrhagic Giant cells Cytotrophoblasts

Microscopic features of Yolk Sac Tumour

Central vessel Double rim of epithelial cells Schiller- du- val body

Worst prognostic feature to see in a teratoma?

Primitive neural tissue Doesn’t respond to chemo

Presentation of tumour

Testicular mass | Painless

What blood test would indicate seminoma?

Elevated LDH (Lactate dehydrogenase)

What serum marked would you expect to find elevated in Teratomas?

Raised: AFP (a-fetaprotein) HCG (human chroionic gonadotropin)

Where to testicular tumers metastasise?

Lymph nodes Lung Brain

Rx testicular ca

Radical orchidectomy + Chemo if 2+ of these factors: - Lymph invasion - Vascular invasion - Embryonal ca - Not a Yolk sac tumour

5 year survival of seminoma

95%

5 year survival of teratoma

90%

Benign conditions of the prostate 2

BNH Proststitis

Cause of BNH

Androgen:Oestrogen imbalance

Microscopic features of prostate

Proliferation of glands and stroma

Rx BNH

1. Drugs: - a-blockers: Doxazosin/ Tamsulosin - 5-a reductase inhibitors: Finasteride/ Dutasteride 2. Trans urethral resection of the prostate - Look for ca

Most common tumour in males

Prostate

Prostate met sites

Bones

What types of prostate ca are there?

Acinar - 90% Ductal 5%

Signs of Prostate ca

Outflow obstruction Haematuria Enlarged prostate on PR exam Elevated PSA

Ix prostate ca

PSA PR Trans Rectal Ultrasound Biopsy (TRUS) MRI/CT Pelvis Bone scan

Rx Prostate ca

1. Radiotherapy 2. Hormonal therapy (if poorly differentiated or high Gleason Score) 3. Radical Prostatectomy if PSA<15 and <65y/o 4. Brachytherapy (radioisotope beads into prostate)

How are prostate tumours graded?

Gleason score

How does Gleason score work?

Grade two commonest parts of the biopsy from 1-5 each Then add up the two scores

How are Prostate tumours graded

pt1 - biopsy or TURP pT2- Confined to 2 lobes of the prostate pT3 Spread into capsule/seminal vesicle pT4- Spread to adjacent organs eg. Rectum, bladder

What 3 factors determine prostate ca prognosis?

Grade Stage PSA level

Length of male urethra

20cm

What are the 3 sections of the male urethra?

Prostatic urethra Membranous urethra Penile urethra

Length of female urethra

3-4cm

RF for cystitis

``` Female Pregnancy BNH Catheterisation DM Radiotherapy ```

Genetics associated with bladder cancer

Mutation in Tumour suppressor gene p16 on chr 9

What is hypospadias?

Urinary meatus opens on the ventral surface of the penis

What is epispadias?

Where the urinary meatus is on the dorsal surface of the penis

What HPV types are associated with penis cancer?

HPV 16 and 18

What is cryptorchidism?

Undescended testes

What congenital syndrome is cryptorchidism linked to?

Prader Willi

Which side is most commonly affected by cryptorchidism?

Right side But can be bilateral

Complications of cryptorchidism

Infertility Cancer (decreased risk if problem sorted before puberty)

What lab finding is found in 10% of seminomas?

B-hCG

How/ where does seminomatous tumours spread?

Lymphatic spread Iliac and para-aortic nodes

Which testicular tumours are hormonally active?

Stromal/sex cord tumours Leydig tumours

Which part of the prostate is commonly affected in BNH?

Central

Signs of Prostate ca

Haematuria Outflow problems Bone pain

Urology Path (1/2 GU) Flashcards

(86 cards)