Urinary Cancers

Renal Cancers

 

Renal Cell Carcinoma (RCC)

This is a malignant epithelial proliferation of the renal tubules, accounting for 90% of renal cancers.

– The most common form is a clear cell carcinoma as the cells look clear on histology.

– Can be sporadic and often seen in males (60 years) or in young children (genetic causes)

 

Symptoms:

– Triad of painless hematuria, loin mass and lumbar pain

– Weight loss+ changes in hormones e.g. ACTH, renin, parathyroid-related protein

– Can cause a left-sided varicocele –> tumour may compress the left renal vein

– Often metastasizes to the lungs and can give a fever

 

Diagnosis:

Ultrasound scan followed by CT scan

 

Treatment:

Radical/Partial Nephrectomy depending on grade as RCC is resistant to chemo/radiotherapy

 

Wilms’ tumour (Nephroblastoma)

This is a malignant kidney tumour of the young renal tubules and kidney cells – it is the most common abdominal malignancy in children, presenting usually around the age of 3.

– Classic Wilms tumour gives a 3-component appearance in histology –> stromal, epithelia and blastemal

– In children <1, this is called a metanephric blastema

Causes:

Most cases are sporadic, but it is also associated with hereditary disorders:

WAGR syndromeWilms tumour, Aniridia (absence of iris), Genital problems, Mental disabilities

Beckwith-Wiedemann syndrome – Wilms tumour + Organomegaly due to mutations in IGF-2

Denys-Drash syndrome – Wilms tumour + Renal glomerulonephritis + male pseudohermaphrotidism

Symptoms:

– Similar to adults (Triad of painless hematuria, loin mass and lumbar pain)

– Weight loss/failure to thrive + enlarged kidneys

Management:

Nephrectomy, younger children have a better prognosis

Bladder Cancers

 

Transitional Cell Carcinoma (TCC)

This is a malignant proliferation of the transitional epithelium which lines the urinary tract, usually seen in elderly males.

– It is the most common type of bladder cancer, usually giving painless macroscopic haematuria

 

Risk factors:

– Working with rubber

– Cigarette smoking

– Chemicals –> dyes and naphthylamine

– Drugs –> Cyclophosphamide

 

Symptoms:

Painless macroscopic hematuria + recurrent UTIs and voiding irritability (+ weight loss)

 

Diagnosis:

– Urine cytology is taken to look at the cells

– Cystoscopy with biopsy is diagnostic

– CT urogram is used to provide staging

– MRI used to show involved pelvic nodes

 

Staging:

The cancer is staged on 3 measures of T=tumour N=nodes and M=metastases

T – T1 (in submucosa) –> T2 (invades muscle) –> T3 (invades perivesical fat) –>  T4 (invades other organs)

N – N0 (no nodes) –> N3 (many nodes)

M – M0 (no metastases) –> M1

Management:

– T1 (most patients) – Transurethral resection of the bladder tumour (TURBT)

– T2-3 – radical cystectomy (removal of bladder) with ileal conduit, can lead to sexual/urinary dysfunction

– T4 – palliative radio/chemotherapy

Squamous Cell Carcinoma

A malignant tumour made of squamous cells occurring after metaplasia

– This is much rarer and is seen after repeated urinary tract infections or Schistosoma haematobium

Adenocarcinoma

This is a malignant tumour of glandular tissue in the bladder

– It is a much rarer form which could be due embryological defects and other rare causes.