Page 281 - Medicine and Surgery

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Chapter 6: Genitourinary oncology 277

Microscopy Palliative radiotherapy is used for symptomatic
Sheets of clear or granular cells with small or normal painful bone or skin metastases.
looking nuclei and cytoplasmic glycogen or fat. They Highly vascular metastases, e.g. in lung or bone may
are similar in appearance to adrenal cortical cells, hence cause pain or haemorrhage which can be treated effec-
‘hypernephroma’. Different histological subtypes have tively by local arterial embolisation.
been described, the most common of which are clear cell Hormonal therapy and immunotherapy are being in-
(75–85%) and papillary/chromophilic (15%). vestigated on a trial basis.

Complications Prognosis
Local spread especially into the renal vein, and may grow If confined to renal capsule 10-year survival is 70%. Very
as far as the inferior vena cava and right atrium. Tumour poor if metastases present, 25% of patients present with
may also spread into neighbouring tissues, such as the metastases and they have a 45% 5-year survival.
adrenal gland and other abdominal organs. Lymphatic
spread is common. Distant spread occurs as cannonball
metastases in bone, lungs, brain or liver. Bladder cancer
Definition
Investigations Bladder cancer is the most common urological malig-
Urinalysis shows haematuria in ∼40%. Blood tests in- nancy, ∼90% of cases are transitional cell carcinoma,
cluding FBC, U&Es, ESR, LFTs and calcium. with the rest being squamous cell carcinoma, adenocar-
Renal ultrasound scan is usually the diagnostic imag- cinoma or mixed/undifferentiated tumour.
ing method. A solid tumour >3cmis diagnostic, but
sometimes a cyst is seen which needs to be differentiated Incidence/prevalence
between a simple benign cyst, a complex cyst or solid Common malignancy; 1 in 5000 in United Kinddom.
tumour. Doppler USS should be performed to look for
renal vein thrombus.
Age
AbdominalCTscanwillshowinmoredetailanysuspi-
Peak age 50–70 years.
cious features: thickened, irregular walls, multiloculated
mass and contrast enhancement. CT will also demon-
strate any local invasion, lymph node and renal vein in- Sex
volvement. M > F
Staging tests include chest X-ray and CT chest, bone
scan. Geography
Increased in the Middle East and industrialised areas.
Management
Surgical removal is the treatment of choice for those Aetiology
without metastases (if there is a single metastasis this There are several risk factors for the development of
can be resected along with the primary tumour). The bladder cancer.
tumour is very resistant to chemotherapy or radiother- Environmental:
apy. In the past, radical nephrectomy with removal of Exposure to certain carcinogens and industries cause
the kidney, perinephric fact, together with the ipsilateral as many as 20% of cases. Aromatic amines, or deriva-
adrenal gland and hilar and para-aortic lymph nodes tives, which are strongly carcinogenic are commonly
was routinely performed. Some now perform either total found in the printing, rubber, textile and petrochemi-
nephrectomy (without removal of the adrenal or lymph cal industries. Diesel exhaust fumes also modestly in-
nodes), or more conservative surgery, i.e. wide resection crease the risk (e.g. for taxi and bus drivers).
or partial nephrectomy, for tumours <5cminsize, but Smokers are two to three times more likely to have
these techniques may have a greater risk of recurrence. bladder cancer than non-smokers.