Urological Malignancies

Renal Cell Carcinoma (RCC)

This is an adenocarcinoma, and its 3 most common types are:

• Clear cell (80%)

• Papillary (15%)

• Chromophobe (5%)

Risk factors - Smoking, Obesity, HTN, End-stage Kidney Failure

Presentation:

• Triad of:

  • Painless haematuria

  • Flank pain

  • Palpable mass

• Non-specific symptoms, such as weight loss, night sweats, fatigue

RCC should suspected if > 45 yrs with unexplained visible haematuria, either w/o UTI or persisting after treatment of UTI.

Commonly metastasises to the Lungs, seen as Cannonball metastases on CXR. The paraneoplastic features of this cancer are:

• Polycythaemia - due to unregulated EPO secretion

• Hypercalcaemia - due to secretion of hormone thatmimics PTH

• HTN - due to multiple factors, like increased renin secretion, polycythaemia and physical compression on adjacent vessels

• Stauffer’s syndrome - abnormal LFTs w/o liver metastasis

A RCC can lead to a Varicocele due to the venous congestion from tumour compression on the renal vein.

N.B. Varicocele is much more common on the left due to anatomy.

Investigations:

Staging CT CAP

Management:

• 1st line is Partial or Radical Nephrectomy

• If not suitable for surgery, other options include arterial embolisation, cryotherapy, and radiofrequency ablation

Testicular Cancer

Arises from the Germ cells in testes, which produce sperm. The 2 types of this cancer are:

• Seminomas - Has a better prognosis

• Non-seminomas - Mostly teratomas, and has a worse prognosis

Risk factors:

• Younger men 15-35 years

• Undescended testes

• Male infertility

• Family hx

Presents with a painless testicular lump that’s non-tender, hard, irregular, with no transillumination.

Commonly metastasises to the Lymphatics, Liver, Lungs, and Brain.

N.B. These most commonly metastasise to the para-aortic lymph nodes.

Investigations:

• USS of scrotum - confirms diagnosis

• Tumour markers - AFP, Beta-hCG, LDH

• Staging CT - Royal Marsden Staging System is used

Management:

• Radical Orchidectomy - a prosthesis can be inserted

• Chemo/Radiotherapy

Bladder Cancer

The 3 types of this are:

• Transitional cell carcinoma (90%)

• Squamous cell carcinoma

• Adenocarcinoma

Risk factors for a transitional cell carcinoma:

• Smoking

• Aromatic amines - found in rubber, dyes, and chemical industry

Risk factors for a squamous cell carcinoma and adenocarcinoma:

• Long term catheterisation (10+ yrs)

• Schistosomiasis infection

• Local bowel cancer

Presentation:

• Painless haematuria

• UTI

• Hydronephrosis

• Neuropathic pain on medial thigh - Due to compression of obturator nerve

Investigations:

• Cystoscopy w/biopsy - for diagnosis

• Staging - Non-muscle invasive or Muscle-invasive

Management:

Surgical:

• TURBT (Transurethral resection of bladder tumour)

• Radical cystectomy - Urostomy w/ileal conduit commonly done after this

Medical:

• Intravesical BCG - stimulates immune system to attack bladder tumour (usually given after the tumour is surgically removed to reduce the risk of recurrence)

• Chemo/radiotherapy