Urinary: Malignancy of the Urinary Tract Flashcards Preview

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Flashcards in Urinary: Malignancy of the Urinary Tract Deck (23)
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1
Q

How common is prostate cancer?

A

The most commonly diagnosed cancer in men, however most will be asymptomatic, localised disease and will be unlikely to die of their prostate cancer.

2
Q

What are the risk factors for prostate cancer?

A

Age - 80% of men over 80 have prostate cancer
Family history - 4x increased risk
Ethnicity - black>white>asian

3
Q

What are some other causes of raised PSA (except cancer)?

A

Infection eg UTI
Prostatitis - inflammation
Enlarged prostate - more tissue to more PSA made

4
Q

What are some symptoms of prostate cancer?

A
  • frequency, urgency and nocturia
  • feeling that bladder has not emptied fully
  • bone pain (prostate cancer spreads to bones)
5
Q

How is prostate cancer diagnosed?

A

Digital rectal examination - the cancer usually grows on the periphery so can be felt
Serum PSA
Guided biopsy

6
Q

What is the gleason score?

A

2 components - the grade of the worst area + the grade of the most common area

7
Q

How is localised prostate cancer treated?

A

Most often just surveillance
Radical prostatectomy - however 1/3 will have erectile dysfunction and 1/3 will have urinary side effects
Radiotherapy, can but radioactive seeds of iodine in the prostate

8
Q

How is metastatic prostate cancer treated?

A

Leutanizing hormone agonists which act on leydig cells in the testis to reduce the amount of testosterone produced (prostate cancer needs testosterone to grow)
Palliative radiotherapy, chemotherapy

9
Q

What is unique about prostate metastasis to bone?

A

It is osteoblastic so builds bone whereas other cancers eg breast are osteoclastic

10
Q

What is the chance of finding malignancy in visible and non visible heamaturia?

A

Visible haematuria: 20% chance of finding malignancy - very high
Non visibile:
Symptomatic 5% chance of malignancy
Asymptomatic 0.5% chance of finding malignancy

11
Q

What is the differential diagnosis for someone presenting with haematuria?

A

Cancer: renal cell carcinoma, upper tract transitional cell carcinoma, bladder cancer, advanced prostate carcinoma

Other: stones, infection, inflammation, benign prostate hyperplasia, glomerular pathology

12
Q

What examinations and investigations would you do for a pt presenting with haematuria?

A

Examinations: blood pressure, abdo mass, digital rectal examination
Investigations: full blood count, urine culture, USS to look for kidney tumours and hydronephresis, flexible cystoscopy to look in bladder

13
Q

What is the epidemiology of bladder cancer?

A

It is the 4th most common cancer in men and 11th in females
Incidence is decreasing due to decreased smoking
More common in men but presents more advanced in women

14
Q

What are the risk factors for bladder cancer?

A
  • smoking increases risk 4x
  • occupational exposure eg painters, handling of carbon, crude oil, rubber or plastics
  • schistosomiasis eg Egypt causes recurrent irritation so get squamous cell carcinoma
15
Q

How do you treat bladder cancer?

A

Low risk non muscle invasive transitional cell carcinoma: may do intravesical chemotherapy
High risk non muscle invasive transitional cell carcinoma:
intravesical immunotherapy
Muscle invasive transitional cell carcinoma:
Neoadjuvant chemo and radica cystectomy (removal of bladder) or radical radiotherapy

16
Q

How common is renal cell carcinoma?

A

7th most common cancer in UK and responsible for 95% of upper urinary tract tumours
More common in males

17
Q

What are the causes of renal cell carcinoma?

A

Smoking, obesity and dialysis

18
Q

How can renal cell carcinoma spread?

A

Directly through peri-renal fat
Via the IVC to the right atrium
Via lymph nodes

19
Q

How do you manage renal cell carcinoma that has not metastasised?

A

Surveillance, removal of a kidney, ablation

20
Q

How do you manage metastatic renal cell carcinoma?

A

Palliative care - renal cell carcinomas respond poorly to chemo and radiotherapy so use molecular therapies targeting angiogenesis

21
Q

How common are upper tract transitional cell carcinomas?

A

Rare - only % of upper tract malignancies

22
Q

How would you investigate an upper tract transitional cell carcinoma?

A

USS to look for hydronephrosis
CT to look for filling defect or ureteric stricture
Biopsy

23
Q

What is the standard treatment for upper tract transitional cell carcinoma?

A

Nephro-ureterctomy : complete removal of the kindey, fat, ureter and cuff of bladder on the affected side

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