Presentation is loading. Please wait.

Presentation is loading. Please wait.

Urological Cancer Kieran Jefferson Consultant Urological Surgeon

Similar presentations


Presentation on theme: "Urological Cancer Kieran Jefferson Consultant Urological Surgeon"— Presentation transcript:

1 Urological Cancer Kieran Jefferson Consultant Urological Surgeon
University Hospital, Coventry

2 Recommended Texts Urology – a handbook for medical students
Brewster, Cranston et al Oxford Handbook of Urology Similar authors, more postgraduate

3 Two-week wait urology Haematuria – Raised PSA/abnormal DRE
frank/microscopic over 50 years old Raised PSA/abnormal DRE Mass in body of testis Renal mass on imaging/palpation Any suspicious penile lesion

4

5 Haematuria Common, major challenge for urologists
Visible haematuria  20% chance cancer Microscopic haematuria  5-10% chance

6 Causes of haematuria Infection Benign prostatic hypertrophy Malignancy
bladder, kidney, ureter, prostate Stone bladder, ureter, kidney Glomerulonephritis IgA nephropathy Trauma

7 Management History and examination Investigations Treatment

8 History Type, duration, associated LUTS or pain Medication
Anticoagulants nephrotoxins Medical/surgical history stone or previous surgery SHx Smoking, chemical exposure, employment

9 Examination Stigmata of renal disease Abdomino-pelvic masses/scars
Hypertension Oedema Abdomino-pelvic masses/scars

10 Investigations Ideally as part of ‘one-stop’ haematuria clinic
MSU  dipstix, M,C&S, cytology FBC, U&Es Flexible cystoscopy USS renal tract +/- or contrast CT

11 Treatment As per aetiology

12 Bladder cancer 4th commonest male/10th commonest female cancer
Risk Factors Age, sex Smoking, exposure to benzene compounds Drugs – phenacetin, cyclophosphamide

13 Bladder cancer subtypes
Primary Transitional cell carcinoma Squamous cell carcinoma Adenocarcinoma Sarcoma Secondary

14 Presentation Symptoms/signs from primary or secondary tumours +/- paraneoplastic phenomena Haematuria, dysuria, frequency/urgency Ureteric obstruction

15 Ureteric obstruction

16 Management As for all cancers, dependent on stage and grade of tumour and co-morbidities TCCs described as GxTy (grade/TNM stage) Can be either curative or palliative

17

18 Diagnosis/staging Clinical diagnosis usually made at flexi cysto
TURBT (including VE or DRE) to establish tissue diagnosis, then Mitomycin If tissue stage pT2 or greater, staging CT chest/abdo/pelvis

19 Treatment Superficial TCC (pT<2) Invasive TCC or other subtypes
TURBT followed by regular review flexi cystoscopy Intravesical treatment with mitomycin or bCG if high grade or multiply recurrent Recurrent high grade disease merits consideration of cystectomy Invasive TCC or other subtypes Radical surgery or radiotherapy after neoadjuvant chemotherapy if cure possible Palliative surgery/radiotherapy/medical symptom control

20 Prognosis Superficial TCC – excellent unless high-grade
Invasive TCC – approx 50% overall 5y/s Metastatic – extremely poor

21 Renal cell cancer UK 7000 cases; 3600 deaths/year 3% all cancer
Mortality is NOT declining >50% incidental findings on imaging 30% present with metastases

22

23

24 Clinical Features Asymptomatic (>50%) Haematuria Flank Pain Mass
Metastatic/paraneoplastic

25 Paraneoplastic Syndromes
Anaemia (>30%) Erythrocytosis (3%) Cachexia Hepatic dysfunction Hormonal abnormalities Hypercalcaemia

26 Metastases Lung Bone Liver Brain

27 Management Dependent on stage, grade & co-morbidity!
Curative vs palliative Only curative option is surgery Laparoscopic radical nephrectomy Lap/open partial nephrectomy Palliation with TKIs and mTOR antagonists

28 Prognosis Good if resectable primary tumour
Very poor for metastatic disease

29 Prostate cancer Commonest solid tumour in UK males
35000 cases & deaths per year Risk factors Age, male sex Significantly less common in oriental races

30

31 Pathology Adenocarcinoma is commonest form (95%+)
Gleason Grading system Sum of two commonest morphologies

32 Presentation Asymptomatic
raised PSA/opportunistic DRE LUTS, lymphoedema, PE/DVT, ureteric obstruction/ARF, haematuria, impotence Bone pain, anaemia, sclerotic bone on XR

33 Management Dependent on stage, grade & co-morbidity!
History & Examination PSA, U/Es, FBC Truss-guided prostate biopsy Isotope bone scan/MRI prostate

34 Selecting treatment Not all tumours warrant treatment (morbidity of treatment outweighs potential benefit to patient) Whitmore’s conundrum ‘Is it possible that no treatable prostate cancer requires treatment, but that all those requiring treatment are untreatable?’

35 Treatment options Curative (radical) Palliative
Radical prostatectomy (open, laparoscopic, robotic) Radical external beam radiotherapy Brachytherapy Palliative Watchful waiting Hormone ablation Chemotherapy Radiotherapy

36 ‘The Third Way’ Active surveillance
Aims to select out patients who will do badly and defer radical treatment until progression is imminent Good evidence that rate of change of PSA correlates well with aggressiveness of tumour Only immediate side-effect is psychological

37 Testicular cancer Commonest solid tumour of young men
Commoner in European populations Exceptionally good prognosis due to effective platinum-based chemotherapy

38

39 Pathology Germ cell tumours (95%) Sertoli cell tumours
Seminoma, teratoma Sertoli cell tumours Leydig cell tumours Lymphomas (older men)

40 Presentation Painless testicular lump
Pain from infarction/infection/trauma Symptomatic metastases Retroperitoneal lymph nodes (varicocoele) Lungs, bones

41 Management Dependent on stage, grade & co-morbidity! But
Almost all are potentially curable Co-morbidity is uncommon in these men

42 Assessment History & Examination Serum Tumour Markers
Αlpha-foetoprotein (AFP) ß-human chorionic gonadotrophin (hCG) Lactate dehydrogenase (LDH) Radical orchidectomy for histology followed by CT chest/abdo/pelvis

43 Oncological management
Most now get chemotherapy Platinum-based Some also radiotherapy and retroperitoneal lymph node dissection Vast majority are cured but need regular imaging and risk second Ca

44 Penile cancer Rare (in UK)
Association with HPV subtypes (cf cervical cancer) Any suspicious lesion on glans or prepuce warrants early referral if fails to respond to steroids Squamous tumours usually treated surgically, some role for radiotherapy/chemo

45 Any questions?


Download ppt "Urological Cancer Kieran Jefferson Consultant Urological Surgeon"

Similar presentations


Ads by Google