Neoplasms of genitourinary system
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Neoplasms of Genitourinary System 泌尿系肿瘤 PowerPoint PPT Presentation


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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

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


Etiology

  • Cause: unknown

  • Risk Factors:

  • cigarette smoking,

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


Etiology

  • RCC occurs in 2 forms:

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

  • --sporadic(散发)


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)

  • 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 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

  • 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 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 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


CT scan of right RCC


CT scan of left RCC


RCC invading renal vein


Left cystic RCC


Left cystic RCC


Differential Diagnosis

  • Benign renal tumors:

  • Angiomyolipoma (血管平滑肌脂肪瘤, 错构瘤)


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)


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

  • Stage 5-year survival rate

  • I 88~100%

  • II 60%

  • III 15~20%

  • IV 0~20%


Renal Pelvic Cancer

肾盂癌


  • Incidence: rare, 3% of all urothelial cancers

  • Pathology:

  • transitional cell 90%

  • squamous cell 10%


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 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


CT scan of right pelvic Ca


CT of right pelvic Ca


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

膀胱癌


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


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 Findings

  • A. Symptoms:

  • hematuria 85~90%

  • irritative voiding symptoms

  • B. Signs:

  • Majority of patients have no pertinent physical signs.


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 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


IVU of Bladder Tumor


CT scan of bladder Ca


Bladder Ca under cystoscopy


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)


After TUR


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 ProstateCaP

前列腺癌


CaP

  • The most common cancer in American men

  • Increases rapidly with age

  • 95% are adenocarcinoma


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 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 Findings

  • D. Prostate biopsy(活检)

  • golden standard

  • E. Imaging

  • TRUS, MRI, Bone scan


Treatment

  • 1. Localized disease

  • (optimal form in great debating)

  • Watchful waiting

  • Radical prostatectomy(根治性前列腺切除)

  • Radiation—external beam


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!


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