MEDI7302 Study Guide - Final Guide: Benzene, Cryoablation, Angiogenesis

53 views8 pages
School
Department
Course
Professor
Renal Tract Tumours
Learning
objectives
Outline the risk factors for urothelial tumours of the renal tract and explain what is
meant by the term ‘field change’ in relation to this condition
Detail a step-wise approach to the management of urothelial tumours
Outline the clinical presentations of renal cell carcinoma and describe the
investigative work-up
Describe the surgical and medical treatment options for renal cell carcinoma
Transitional/
urothelial cell
carcinoma
[bladder]
Types of bladder cancer
Primary tumors Urothelial cancers - 90+% cases
Non-urothelial cancers - rare
Squamous cell carcinoma - 5%
Adenocarcinoma - 1%
Small cell carcinoma, rhabdomyosarcoma,
primary lymphoma
Secondary tumors Extremely rare
Metastatic tumors originating from melanoma,
colon, prostate, lung and breast
Risk factors
Male gender (M:F is 43:148)
Age 65yo (elderly)
Carcinogens (PeeSAC)
Phenacetin - compound analgesic no longer in use
Smoking - most common; phenyl-B-naphthylamine are active agents
Analine - organic compound used in aniline dyes; occupations
revolving around textiles, tyre/rubber, petroleum
Cyclophosphamide - chemotherapeutic agent
Alcohol abuse
Prolonged extended bladder times
Radiation
Other medications - piogliazone
'Field change/ cancerization'
Renal pelvis, ureter, bladder and proximal urethra are lined by transitional
epithelium (urothelium, 3-7 cell layers, umbrella cells form tight junctions for barrier
function + stretchability
Tumor development of urothelium is often multi-focal compared to other
sites via 2 mechanisms
Field change - urothelium undergoes widespread carcinogenic
alteration(s) after exposure to long-term injurious environment, hence more
susceptible to malignant transformation (usually multifocal and recurring)
Tumor cell implantation - tumor cells in one location lose their
attachments and float in urine until they attach/ implant at another site, usually in
head-to-toe direction (eg renal pelvis -> ureters), prone to mets to local structures
2 main forms of UCCs
P53 dependent - flat tumor, urothelial cells grow horizontally and
grow deeper into tissues
P53 independent - finger-like extensions (papilla) grow outward into
bladder lumen
Clinical presentation
PC Painless hematuria (gross and high level microscopic -
most common presenting sx; always consider UCC unless proven
otherwise
LUTS - urinary frequency, urgency, dysuria
Advanced cancer - abdominal mass, bone pain (bone
mets), flank pain (blocked ureter), retroperitoneal mets
Other hx Urological hx - LUTS, painless hematuria
find more resources at oneclass.com
find more resources at oneclass.com
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 8 pages and 3 million more documents.

Already have an account? Log in
Past hx bladder tumors
Smoking or occupational related hx
Exam Abdominal exam - look for masses arising out of pelvis
Bimanual/ rectal exam - masses, mobility of masses
Investigations Haematological - FBC, CHEM20 (Hb, urine function)
Urine m/c/s - confirm hematuria, rule out other causes
(eg infection, certain vegetable dyes)
Urine cytology - 3 samples on 3 different days; very
specific test
Low grade tumours rarely have +ve cytology VS
high grade usually have +ve cytology (due to exfoliatory nature of
poorly differentiated cells comprising tumor)
Malignant cytology indicates 95% chance a
urothelial cancer exists
CT IVP (upper tract)
Flexible cystoscopy (lower tract) - diagnostic and
therapeutic
Any bladder tumors can be resected & sent for
histology
Classic TCC bladder (papillary appearance -
each papilla have capillary network that is usually inflicted during
voiding, hence causing painless hematuria)
If risk of mets
Liver function test (ALP)
CT CAP (staging scans)
Bone scan (if elevated ALP)
TMN Staging
Tx -
cannot assess
T0 - no
tumor
Ta - no
invasion
T1 -
invades lamina propria
T2 -
invades muscularis propria
T3 -
perivesical invasion
T4a -
invades prostate, uterus or
vagina
T4b -
find more resources at oneclass.com
find more resources at oneclass.com
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 8 pages and 3 million more documents.

Already have an account? Log in
invades pelvic/ abdominal
wall
Nx -
cannot assess
N0 - no
nodes
N1 - 1
node, true pelvis
N2 -
multiple nodes, true pelvis
N3 -
any common iliac nodes or
above
Management
Preparation Cease smoking
Non-muscle
invasive
Bladder cancer is a recurring disease
TURBT (transurethral resection of bladder tumor)- tumor
resection via cystoscope +/- follow up chemotherapy
Low grade - intravesical chemotherapy via
mitomycin C (catheter based)
High grade/ CIS disease - intravesical BCG
vaccine immunotherapy
Follow up - surveillance flexible cystoscopies +/- urine
cytology
Muscle
invasive
Must have high surgical fitness to survive surgery
Radical cystectomy + ileoconduit or neobladder urinary
diversion
Ileoconduit
(urostomy)
Stoma bag for urine via
sewing ureters to resected piece of ileum
Neobladder Resected ileum is attached
between ureters and urethra
No nerve signals when
bladder becomes full, hence require schedule to empty
bladder
find more resources at oneclass.com
find more resources at oneclass.com
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 8 pages and 3 million more documents.

Already have an account? Log in

Document Summary

Outline the risk factors for urothelial tumours of the renal tract and explain what is meant by the term field change" in relation to this condition. Detail a step-wise approach to the management of urothelial tumours. Outline the clinical presentations of renal cell carcinoma and describe the. Describe the surgical and medical treatment options for renal cell carcinoma. Phenacetin - compound analgesic no longer in use. Smoking - most common; phenyl-b-naphthylamine are active agents. Analine - organic compound used in aniline dyes; occupations revolving around textiles, tyre/rubber, petroleum. Renal pelvis, ureter, bladder and proximal urethra are lined by transitional epithelium (urothelium, 3-7 cell layers, umbrella cells form tight junctions for barrier function + stretchability. Tumor development of urothelium is often multi-focal compared to other sites via 2 mechanisms. Field change - urothelium undergoes widespread carcinogenic alteration(s) after exposure to long-term injurious environment, hence more susceptible to malignant transformation (usually multifocal and recurring)

Get access

Grade+20% off
$8 USD/m$10 USD/m
Billed $96 USD annually
Grade+
Homework Help
Study Guides
Textbook Solutions
Class Notes
Textbook Notes
Booster Class
40 Verified Answers

Related Documents