Neoplasms of genitourinary system
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Neoplasms of Genitourinary System 泌尿系肿瘤. Adenocarcinoma of the Kidney. ( Renal Cell Carcinoma, RCC, 肾细胞癌). RCC. In US(1999), 30,000 new cases diagnosed, 11,900 deaths from this disease RCC accounts for 3% of adult cancers, 85% of all primary malignant renal tumors

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Neoplasms of Genitourinary System 泌尿系肿瘤

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Neoplasms of genitourinary system

Neoplasms of Genitourinary System泌尿系肿瘤


Adenocarcinoma of the kidney

Adenocarcinoma of the Kidney

( Renal Cell Carcinoma, RCC, 肾细胞癌)


Neoplasms of genitourinary system

RCC

  • In US(1999), 30,000 new cases diagnosed, 11,900 deaths from this disease

  • RCC accounts for 3% of adult cancers, 85% of all primary malignant renal tumors

  • RCC occurs most commonly in 5th~6th decade, male-female ratio 2:1


Etiology

Etiology

  • Cause: unknown

  • Risk Factors:

  • cigarette smoking,

  • exposure to asbestos (石棉)and tanning(鞣革)products


Etiology1

Etiology

  • RCC occurs in 2 forms:

  • --inherited(遗传):chromosome translocation, Von Hippel-Lindau disease

  • --sporadic(散发)


Pathology

Pathology

  • RCC originates from the proximal renal tubular epithelium.

  • Types:

  • Clear cell type

  • Granular cell type

  • Mixed cell type

  • RCC is most often a mixed adenocarcinoma(腺癌).


Tumor staging robson system

Tumor Staging (Robson System)

  • I: Tumor is confined within the kidney parenchyma.

  • II: Tumor involves the perinephric fat but confined within Gerota’s fascia (including the adrenal).

  • IIIA: Tumor involves the main renal vein/inferior vena cava.


Tumor staging robson system1

Tumor Staging (Robson System)

  • IIIB: Tumor involves regional LN.

  • IIIC: Tumor involves both local vessels and LN.

  • IVA: Tumor involves adjacent organs other than the adrenal.

  • IVB: Distant metastases.


Clinical findings

Clinical Findings

  • Symptoms & Signs

  • A. Classical triad——gross hematuria, flank pain, palpable mass (only in 10~15% advanced cases)

  • Symptoms secondary to metastatic disease: dysnea & cough, seizure & headache, bone pain

  • Renal tumors are increasingly detected incidentally by CT or ultrasound


Clinical findings1

Clinical Findings

  • B. Paraneoplastic Syndromes:

  • erythrocytosis(红细胞增多症), hypercalcemia(高钙血症), hypertension

  • C. Lab Findings:

  • anemia, hematuria(60%), ESR↑,


Clinical findings2

Clinical Findings

  • D. X-ray Findings:

  • *Ultrasonography

  • *Intravenous Urography (IVU): 75% accurate (used alone), calcification

  • *CT scanning: more sensitive, mass +renal hilum, perinephric space and vena cava, adrenals, regional LN and adjacent organs

  • *Renal Angiography


Ivu of right rcc

IVU of right RCC


Ct scan of right rcc

CT scan of right RCC


Ct scan of left rcc

CT scan of left RCC


Rcc invading renal vein

RCC invading renal vein


Left cystic rcc

Left cystic RCC


Left cystic rcc1

Left cystic RCC


Differential diagnosis

Differential Diagnosis

  • Benign renal tumors:

  • Angiomyolipoma (血管平滑肌脂肪瘤, 错构瘤)


Treatment

Treatment

  • 1. Localized disease:

  • Surgical removal---only potentially curative therapy

  • Radical Nephrectomy (en bloc removal of the kidney and Gerota’s fascia including ipsilateral adrenal, proximal ½ ureter, regional lymphadenectomy (淋巴结清扫)


Treatment1

Treatment

  • 2.Disseminated disease:

  • nephrectomy--- reducing tumor burden

  • radiation--- radioresistant tumor, metastases 2/3 effective

  • chemotherapy--- <10% effective

  • immunotherapy--- IL-2/interferon-alpha, 30% response rate


Prognosis

Prognosis

  • Stage 5-year survival rate

  • I 88~100%

  • II 60%

  • III 15~20%

  • IV 0~20%


Renal pelvic cancer

Renal Pelvic Cancer

肾盂癌


Neoplasms of genitourinary system

  • Incidence: rare, 3% of all urothelial cancers

  • Pathology:

  • transitional cell 90%

  • squamous cell 10%


Clinical findings3

Clinical Findings

  • A. Symptoms & Signs

  • gross hematuria 70~90%

  • flank pain 8~50%

  • B. Lab Findings:

  • hematuria, cytology (40% positive), tumor markers (BTA, NMP22)


Clinical findings4

Clinical Findings

  • C. Imaging

  • IVU---intraluminal filling defect, unilateral nonvisualization of the collecting system, hydronephrosis

  • US, CT & MRI

  • Ureteropyeloscopy (肾盂输尿管镜)


Ivu of right pelvic ca

IVU of right pelvic Ca


Ct scan of right pelvic ca

CT scan of right pelvic Ca


Ct of right pelvic ca

CT of right pelvic Ca


Treatment2

Treatment

  • Standard therapy---nephroureterectomy (肾输尿管全长切除)

  • removal of the entire distal ureter with a small cuff of bladder


Bladder carcinoma

Bladder Carcinoma

膀胱癌


Bladder ca

Bladder Ca

  • The second most common cancer of the genitourinary system, male-female ratio 2.7:1

  • Initiators/Promoters:

  • cigarette smoking

  • occupational exposure

  • genetic events


Staging tnm system

Staging: TNM System


Histopathology

Histopathology(组织病理学)

  • Transitional cell carcinoma(移行细胞癌)90%

  • Nontransitional cell carcinoma: adenocarcinoma, squamous cell Ca, undifferentiated Ca


Clinical findings5

Clinical Findings

  • A. Symptoms:

  • hematuria 85~90%

  • irritative voiding symptoms

  • B. Signs:

  • Majority of patients have no pertinent physical signs.


Clinical findings6

Clinical Findings

  • C. Lab tests:

  • urine test——hematuria

  • urinary cytology——depend on grade and volume of the tumor

  • other markers: BTA, NMP22, telomerase(端粒酶)


Clinical findings7

Clinical Findings

  • D. Imaging:

  • Ultrasonography—screen

  • IVU—evaluation of upper urinary tract

  • CT/MRI—assessment of the depth of infiltration and pelvic LN enlargement

  • E. Cystoscopy(膀胱镜)


Ultrasonography of bladder ca

Ultrasonography of Bladder Ca


Ivu of bladder tumor

IVU of Bladder Tumor


Ct scan of bladder ca

CT scan of bladder Ca


Bladder ca under cystoscopy

Bladder Ca under cystoscopy


Treatment3

Treatment

  • 1. Surgery

  • TUR (Trans-Urethral Resection)

  • Partial Cystectomy (膀胱部分切除)

  • Radical Cystectomy(根治性膀胱全切除)

  • 2. Radiotherapy


Tur of bladder tumor turbt

TUR of Bladder Tumor (TURBT)


After tur

After TUR


Treatment4

Treatment

  • 3. Intravesical Chemotherapy(膀胱内化疗)

  • molecular response

  • weight rate

  • Mitomycin C 329 39~78%

  • Thiotepa 189 up to 55%

  • Doxorubicin 580 mean 38%

  • BCG 36~71%


Carcinoma of the prostate cap

Carcinoma of the ProstateCaP

前列腺癌


Neoplasms of genitourinary system

CaP

  • The most common cancer in American men

  • Increases rapidly with age

  • 95% are adenocarcinoma


Clinical findings8

Clinical Findings

  • A. Symptoms

  • early stage: asymptomatic(无症状)

  • locally advanced/metastatic disease—obstructive or irritative voiding complaints, bone pain, paresthesias(感觉异常)and weakness of lower extremities

  • B. Signs: DRE—induration(硬结)


Clinical findings9

Clinical Findings

  • C. Tumor markers

  • PSA(前列腺特异抗原)Prostate Specific Antigen

  • < 4 ng/ml normal

  • 4 ~ 20 ng/ml Grey Zone

  • > 20 ng/ml highly suspect of PCa


Clinical findings10

Clinical Findings

  • D. Prostate biopsy(活检)

  • golden standard

  • E. Imaging

  • TRUS, MRI, Bone scan


Treatment5

Treatment

  • 1. Localized disease

  • (optimal form in great debating)

  • Watchful waiting

  • Radical prostatectomy(根治性前列腺切除)

  • Radiation—external beam


Treatment6

Treatment

  • 2. Locally advanced/metastatic diseases

  • Endocrine therapy—complete androgen blockade : orchiectomy睾丸切除+antiandrogen agent (flutamide, 氟他胺) or LHRH agonist(类似物)

  • Radiation


Thanks for your attention

Thanks for your attention!


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