Urological Cancer

BLADDER CANCER

• 2nd commonest urological malignancy

• 3.5% of all cancers worldwide

• M:F = 2:1

• Incidence increases with age

AETIOLOGY

• Smoking

• Occupational

• Chronic infection

• Drugs

• Genetic/Familial

HISTOPATHOLOGY

• Transitional Cell

• Squamous Cell

• Adenocarcinoma

HISTOPATHOLOGY

• Field Change

• Grade 1-3

• Stage Ta – T4

N0-N1

M0-M1

PRESENTATION

• Haematuria

• Infection

• Mass

INVESTIGATION

• Cystoscopy

• CT

• MRI

TREATMENT

• SUPERFICIAL – Transurethral Resection – Intravesical Chemo/Immunotherapy

• INVASIVE – Radical Surgery – Radiotherapy – Systemic Chemotherapy

Superficial >80% 5-year survival

Invasive 25-50% 5-year survival

PROSTATE CANCER

• Commonest male cancer (33%)

• Increasing incidence younger males

• Case fatality rate 20%

AETIOLOGY

• Testosterone

• Race

• Family History

• Diet

• Smoking

HISTOPATHOLOGY

• Peripheral zone

• Local spread

– Perineural

– seminal vesicle

• Metastatic spread

– regional lymph nodes

– bones, lungs, viscera

Seminal Vesicle

HISTOPATHOLOGY

• Adenocarcinoma

• Prostatic Intraepithelial Neoplasia

• Grade: Gleason Score 2-10

• Stage T1-4, N0-1, M0-1

PRESENTATION

ASYMPTOMATIC

• Raised Prostate Specific Antigen

• Abnormal Digital Rectal Examination

PRESENTATION

LOCAL SYMPTOMS

• Haematuria

• Haematospermia

• Bladder Outlet Obstruction

PRESENTATION

ADVANCED SYMPTOMS

• Lymphoedema

• Pathological Fracture

• Spinal Cord Compression

• Anaemia

• Ureteric Obstruction

INVESTIGATION

• PSA

• Transrectal Ultrasound Biopsy

• Isotope Bone Scan

• CT

• MRI

Staging Prostate Cancer

T1 T2

T3 T4

N1

M1

Gleason Grade

Gleason Score • Gleason grading

• Sum of Dominant and sub-dominant histology

+ = 7 3 4

TREATMENT

CONSERVATIVE

• Watchful Waiting

• Active Surveillance

TREATMENT

CURATIVE

• Radical Prostatectomy

• Radiotherapy

• Open prostatectomy

Radical Prostatectomy

• Laproscopic prostatectomy

Radical Prostatectomy

• Robotic prostatectomy

Radical Prostatectomy

• Robotic prostatectomy

– Enhanced magnification, scaling and movement

– Reduced blood loss

– Reduced post operative pain

– Faster recovery

Radical Prostatectomy

Prostate Cancer Radiotherapy

• Target identification – Tumour

– Prostate

– Seminal Vesicles

• Organs at risk – Rectum

– Bladder

– Penile Bulb

TREATMENT

ADVANCED DISEASE

Endocrine Therapy

Chemotherapy

• Corticosteroids

• Palliation

PROGNOSIS

• Early

Most live > 10y

• Metastatic

Few survive 5y

RENAL CANCER

• 2% of all cancers

• >200 new cases annually in NI

• M:F = 2:1

• Highest incidence >75 y/o

AETIOLOGY

• Inherited

Von Hippel-Lindau Syndrome

Hereditary Papillary Renal Cell Carcinoma Syndrome

• Smoking

• Obesity

• Polycystic renal disease

HISTOPATHOLOGY

• Solid/Cystic

• Clear cell 75%

• Papillary 10%

• Chromophobe 10%

• Oncocytoma

• Collecting duct tumours Glomerulus

Tubule

Clear Cell Tumour

PRESENTATION

• 40% Incidental

• Haematuria

• Mass

• Pain

PRESENTATION

LATE

• Paraneoplastic phenomena

• Metastatic

• Varicocoele

INVESTIGATION

• Ultrasound

• CT

• MRI

• Angiography

TNM STAGING

TREATMENT

Organ-Confined

• Radical Nephrectomy

• Nephron Sparing Surgery

TREATMENT

Metastatic

• Palliative irradiation/surgery/embolisation

• Immunotherapy

• Growth factor receptor inhibitors

PROGNOSIS

• T1-2 N0 M0 80% 5 year survival

• Metastatic disease 10% 5 year survival

TESTICULAR CANCER

• Commonest cancer males age 15–34

• 85% 20–50 y/o

• 1-2% all male cancers

RISK FACTORS

• Cryptorchidism

• Previous History

• Family History

HISTOPATHOLOGY

95% Germ Cell

Seminoma

Teratoma (Non Seminoma)

Lymphoma

Sertoli

Leydig Cell

Metastases

PRESENTATION

• Most present early

• Painless mass

• Hydrocoele

• Undescended – inguinal or pelvic mass

• Metastases

INVESTIGATION

• Tumour Markers – a-FetoProtein

– b-Human Chorionic Gonadotrophin

– Lactate Dehydrogenase

• Pathology

INVESTIGATION

Imaging

• Ultrasound

• CT

• MRI

TREATMENT

• Radical Orchidectomy

• Adjuvant Therapy

– Seminoma

• Radiotherapy

• Chemotherapy

– Non Seminomatous Germ Cell Tumour (Teratoma)

• Combination Chemotherapy

• Retroperitoneal Lymph Node Dissection

PROGNOSIS

98% >10 year survival

Treatment Risks

• Carcinogenesis

• Pulmonary fibrosis

• Peripheral neuropathy