Part 12



What % of patients with visible haematuria have urinary tract cancer 

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Urgent referral within two weeks

>45 y/o :

Unexplained Visible haematuria without UTI 

VH that persists or recurs after successful treatment of UTI 

> 60 y/o

Unexplained NVH and either dysuria or raised WBC 

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Swelling of the kidney due to build-up of urine due to an obstruction or blockage 

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Visible haematuria

Other causes for what apart from cancer? 





Foreign bodies 

Drugs (anti-coagulants, NSAIDs) 

Prostatic disease 

Nephritis, IgA 

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Bladder cancer

Stages of what cancer? 

Tis = carcinoma insitu 'flat-tumour', only found on the surface. Non-muscle invasive muscle cancer. Often comes back after treatment 

Ta/T1 = non-invasive 

T2 = invaded detrusor muscle 

T3 = beyond detrusor 

T4 = Beyond detrusor, fat, the organ altogether

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Bladder cancer treatment

Non muscle invasive = 80% 

Transurethral resection 

Adjuvant intravesical therapy (chemo or anti-immune agent 'BCG') 

Muscle Invasive = 20% 

Radical cystectomy and urinary diversion 

Radical radiotherapy 

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Renal cancer

Stage 1 = <7cm 

Stage 2 = >7cm 

Stage 3 = invading renal vein / IVC 

Stage 4 = invading further up the IVC, even to the point of the RA (and / or invading lymph nodes) 

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Renal cancer treatment

Stage 1 = partial nephrectomy 

Stage 2-4 = Radical nephrectomy 

Chemo and radiotherapy is not used in this type of cancer, only immunotherapy (VEGF inhibitors) 

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What is the 5 year survival of prostate cancer? 

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Prostate cancer


Often None 

Lower UTI 

Late symptoms = 


Lower urinary tract symptoms 


Weight loss 

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Prostate cancer

T1 = too small to be seen on MRI or felt, diagnosed at TURP (Transurethreal resection of ...) or biopsy 

T2 = confined to ... 

T3 = Breached capsule and may invade seminal vesicles 

T4 = invasion to other organs 

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Side effects of treatment for prostate cancer

Erectile dysfunction (80-90%) 

Urinary incontinence 

Rectal bleeding (proctitis) 

Urinary bleeding (cystitis) 

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Where does prostate cancer often spread to first in metastatic disease 

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Androgen deprivation therapy

What is the first line treatment in metastatic prostate disease 

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Androgen deprivation therapy

Not curative but allows for palliation 

LHRH agonists (competitive with LH, down regulates LH via negative feedback and therefore reduces testosterone) 

LHRH antagonists 

Anti-androgens (at cellular level) 

All act to reduce the effects of testosterone 

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Testicular cancer


Lump, skin changes 

Weight loss 

Back pain 



Undescended testes (big risk factor) 


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First lymph nodes testicular cancer often spreads to 

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Differential diagnosis for testicular cancer

V - Variocle 

I - Infection (epididimoorhcitis, abscess) 

T - Trauma 

M - morphology 

N - neoplasm 


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Testicular cancer

Tumour markers for what cancer ?




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Avoids the spread of metastases

Why when performing a radical orchidectomy do we do so through the inguinal canal? 

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Treatment for testicular cancer

Low risk = radical orchidectomy + monitoring (CT of chest, abdo, pelvis. Check tumour markers) 

High risk = radical orchidectomy + chemo + monitoring 

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What percentage of testicular cancers are from germ cells? 

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Adjuvant prophylactic chemo for testicular cancer

Seminoma = carboplatin, 1 cycle 

Non-seminoma = BEP (bleomycin, etoposide, platinum (cisplatin)) 2 cycles 

Metastatic = Systemic chemo - BEP (3-4 cycles) + retroperitoneal lymph node dissection for residual masses 

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Pancreatic cancer

Risk factors for what cancer: 

Smoking - strongest 

Diet rich in animal fats and proteins 


FHx: > 3 first degree relatives = x20 

Hereditary symptoms: Lynch, Peutz-Jeghers 

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Pancreatic cancer


70% dull peigastric pain (radiating to / or middle back - esp cancer of the tail) 

Jaundice (10%) painless - dark urine, pale stools, itching 

Weight loss (>10% body weight)

Sickness, steatorrhoea, blood clots, diabetes 

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Courvoisiers law

In the presence of a palpably enlarged gall bladder, which is non-tender with mild painless jaundice. - unlikely to be gall stones 

Gall stone = repeat infection, causing fibrosis of the gall bladder, not palpable 

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Pancreatic tumour marker?

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Pancreatic cancer Staging

T1 = inside the organ <2cm in any direction 

1a = <0.5 

1b = <1cm 

1c < 2cm 

T2 = within organ but 2-4cm in any direction 

T3 = within organ but >4cm 

T4 = involvement of nearby blood vessels 

N1 = 1-3LN 

N2 = >4LNs 

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Pancreatic cancer

Resectable if less than 3 cm and head of organ involved as presents with jaundice earlier 

Less likely to be resectable if body or tail involved as these tend to present later and nearby LN or major blood vessels involved 

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PPPD, Whipple. Total pnacreatomy

What are the three types of surgery for pancreatic cancer? 

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Exocrine adenocarcinomas of the pancreas

Most common type of pancreatic cancer 

>80% of ductal carcinomas 

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Cystic tumours of the pancreas

Most are benign, have better prognosis than other exocrine pancreatic cancers 

Cancer of the acinar cells (end of ducts that make the juices) 

Presents at a younger age than adenocarcinomas 

Slower growing 

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Endocrine pancreatic tumours (PNETs)

Aka islet cell tumours 

Mostly benign 

1/3 release hormones leading to symptoms 

2/3rds therefore are non-functioning (however non-functioning are more likely to be malignant) 

Better prognosis than adenocarcinomas of the pancreas 

Grading based on differentiation, Well differentiated = low and intermediation grade whereas poorly differentiated = high grade with rapid growth and spread 

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Tumour marker in PNETs 

In high grade >20% 

Low grade < 20% 

cellular marker for proliferation 

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