๐ Key Learning
- Unexplained painless haematuria is a red flag symptom in adults.
- RCC often presents with a classic triad: haematuria, flank pain, abdominal mass (but rarely all together).
- Testicular cancer affects young men (20โ40) โ diagnosis is clinical + USS, never biopsy.
- Bladder cancer has a high recurrence rate โ follow-up is crucial.
- Penile cancer is rare but linked strongly with HPV infection.
๐งช Renal Cell Carcinoma (RCC)
- Most common renal malignancy, esp. clear cell subtype
- Origin: Proximal tubule
- RFs: Smoking, industrial exposure, dialysis
๐ Clinical Features
- Haematuria, flank pain, abdominal mass
- Left varicocele (due to gonadal vein compression)
-
Paraneoplastic:
- Excess production of EPO โ polycythaemia
- Parathyroid hormone excess โ Hypercalcaemia
- Excess renin โ Hypertension
- Stauffer syndrome โ hepatic dysfunction without metastasis - Hepatosplenomegaly and cholestasis
๐งช Investigations
- CT abdomen-pelvis (with contrast) โ gold standard
๐ Management
- Nephrectomy (partial or radical)
- Poor response to chemo; immunotherapy (IL-2, IFN-ฮฑ) used in some cases
๐งช Bladder Cancer
- Transitional cell carcinoma = 90%
- RFs: Smoking, age, aromatic hydrocarbons (aniline dyes, rubbers), schistosomiasis
๐ Clinical Features
- Painless haematuria
- Storage LUTS or recurrent UTIs
๐งช Investigations
- Flexible cystoscopy 1st line
- TURBT (therapeutic + diagnostic)
๐ Management
- TURBT ยฑ intravesical BCG/mitomycin
- Radical cystectomy for muscle-invasive disease
๐งช Testicular Cancer
- Germ cell tumours = 95% (seminomas & NSGCTs)
- RF: Cryptorchidism
- Peak age: 20โ40 years
๐ Clinical Features
- Painless lump
- Commonly fixed, irregular, firm
๐งช Investigations
-
Tumour markers:
- Seminomas: โ ฮฒHCG (20%), normal AFP
- NSGCTs: โ ฮฒHCG and/or AFP
- 1st line: USS testis
- CT-TAP
- No biopsy โ risk of seeding
๐ Management
- Radical orchidectomy
- ยฑ adjuvant chemo for NSGCTs
๐งช Penile Cancer
- Most are squamous cell carcinomas
- RFs: HPV (types 6, 16, 18)
๐ Clinical Features
- Painless ulcerating lesion on glans or foreskin
- Inguinal lymphadenopathy
๐งช Investigations
- Biopsy, PET, CT TAP
๐ Management
- Topical chemo (e.g. 5-FU) if superficial
- Surgical excision required in most cases
๐จ 2 Week Wait Referral Criteria (NICE)
| Cancer Type | Age | Referral Criteria | Referral Type |
|---|---|---|---|
| Bladder Cancer | โฅ45 | Unexplained visible haematuria, without urinary tract infection (UTI) | 2WW referral |
| โฅ45 | Visible haematuria that persists after treatment of UTI | 2WW referral | |
| โฅ60 | Unexplained non-visible haematuria and either: โ white cell count or dysuria | 2WW referral | |
| Renal Cancer | โฅ45 | Unexplained visible haematuria, without UTI | 2WW referral |
| โฅ45 | Visible haematuria that persists after treatment of UTI | 2WW referral | |
| Prostate Cancer | Any age | PSA above age-specific threshold | 2WW referral |
| Any age | Abnormal digital rectal examination (DRE) (e.g. craggy, hard, irregular prostate) | 2WW referral | |
| Testicular Cancer | Any age | Non-painful enlargement or change in shape/texture of testicle | 2WW referral |
| Any age | Unexplained or persistent testicular symptoms | Consider direct access USS | |
| Penile Cancer | Any age | Penile mass or ulcer, STI excluded or persists after STI treatment | 2WW referral |
| Any age | Unexplained symptoms affecting foreskin or glans | 2WW referral |
๐ Exam Clues & Clinchers
- Cannonball mets on CXR = think RCC
- ฮฒHCG + AFP raised = NSGCT
- Painless haematuria in smoker = bladder cancer
- Penile ulcer + HPV history = SCC of the penis