Neoplasms of Genitourinary System ?????

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Neoplasms of Genitourinary System?????
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Adenocarcinoma of the Kidney

• ( Renal Cell Carcinoma, RCC, ????)

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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 5th6th decade,
  male-female ratio 21

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Etiology

• Cause unknown
• Risk Factors
• cigarette smoking,
• exposure to asbestos (??)and
  tanning(??)products

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Etiology

• RCC occurs in 2 forms
• --inherited(??)chromosome translocation, Von
  Hippel-Lindau disease
• --sporadic(??)

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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(??).

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Tumor Staging (Robson System)

• I Tumor is confined within the kidney
  parenchyma.
• II Tumor involves the perinephric fat but
  confined within Gerotas fascia (including the
  adrenal).
• IIIA Tumor involves the main renal vein/inferior
  vena cava.

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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.

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Clinical Findings

• Symptoms Signs
• A. Classical triadgross hematuria, flank pain,
  palpable mass (only in 1015 advanced cases)
• Symptoms secondary to metastatic disease
  dysnea cough, seizure headache, bone pain
• Renal tumors are increasingly detected
  incidentally by CT or ultrasound

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Clinical Findings

• B. Paraneoplastic Syndromes
• erythrocytosis(??????), hypercalcemia(????),
  hypertension
• C. Lab Findings
• anemia, hematuria(60), ESR?,

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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

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IVU of right RCC
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CT scan of right RCC
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CT scan of left RCC
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RCC invading renal vein
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Left cystic RCC
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Left cystic RCC
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Differential Diagnosis

• Benign renal tumors
• Angiomyolipoma (????????, ???)

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Treatment

• 1. Localized disease
• Surgical removal---only potentially curative
  therapy
• Radical Nephrectomy (en bloc removal of the
  kidney and Gerotas fascia including ipsilateral
  adrenal, proximal ½ ureter, regional
  lymphadenectomy (?????)

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Treatment

• 2.Disseminated disease
• nephrectomy--- reducing tumor burden
• radiation--- radioresistant tumor, metastases
  2/3 effective
• chemotherapy--- lt10 effective
• immunotherapy--- IL-2/interferon-alpha, 30
  response rate

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Prognosis

• Stage 5-year survival rate
• I 88100
• II 60
• III 1520
• IV 020

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Renal Pelvic Cancer

• ???

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• Incidence rare, 3 of all urothelial cancers
• Pathology
• transitional cell 90
• squamous cell 10

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Clinical Findings

• A. Symptoms Signs
• gross hematuria 7090
• flank pain 850
• B. Lab Findings
• hematuria, cytology (40 positive), tumor
  markers (BTA, NMP22)

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Clinical Findings

• C. Imaging
• IVU---intraluminal filling defect, unilateral
  nonvisualization of the collecting system,
  hydronephrosis
• US, CT MRI
• Ureteropyeloscopy (??????)

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IVU of right pelvic Ca
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CT scan of right pelvic Ca
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CT of right pelvic Ca
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Treatment

• Standard therapy---nephroureterectomy (????????)
• removal of the entire distal ureter with a
  small cuff of bladder

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Bladder Carcinoma

• ???

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Bladder Ca

• The second most common cancer of the
  genitourinary system, male-female ratio 2.71
• Initiators/Promoters
• cigarette smoking
• occupational exposure
• genetic events

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Staging TNM System
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Histopathology(?????)

• Transitional cell carcinoma(?????)90
• Nontransitional cell carcinoma adenocarcinoma,
  squamous cell Ca, undifferentiated Ca

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Clinical Findings

• A. Symptoms
• hematuria 8590
• irritative voiding symptoms
• B. Signs
• Majority of patients have no pertinent
  physical signs.

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Clinical Findings

• C. Lab tests
• urine testhematuria
• urinary cytologydepend on grade and volume
  of the tumor
• other markers BTA, NMP22, telomerase(???)

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Clinical Findings

• D. Imaging
• Ultrasonographyscreen
• IVUevaluation of upper urinary tract
• CT/MRIassessment of the depth of
  infiltration and pelvic LN enlargement
• E. Cystoscopy(???)

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Ultrasonography of Bladder Ca
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IVU of Bladder Tumor
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CT scan of bladder Ca
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Bladder Ca under cystoscopy
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Treatment

• 1. Surgery
• TUR (Trans-Urethral Resection)
• Partial Cystectomy (??????)
• Radical Cystectomy(????????)
• 2. Radiotherapy

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TUR of Bladder Tumor (TURBT)
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After TUR
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Treatment

• 3. Intravesical Chemotherapy(?????)
• molecular response
• weight
  rate
• Mitomycin C 329 3978
• Thiotepa 189 up to 55
• Doxorubicin 580 mean 38
• BCG 3671
  

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Carcinoma of the ProstateCaP

• ????

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CaP

• The most common cancer in American men
• Increases rapidly with age
• 95 are adenocarcinoma

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Clinical Findings

• A. Symptoms
• early stage asymptomatic(???)
• locally advanced/metastatic diseaseobstructive
  or irritative voiding complaints, bone pain,
  paresthesias(????)and weakness of lower
  extremities
• B. Signs DREinduration(??)

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Clinical Findings

• C. Tumor markers
• PSA(???????)Prostate Specific Antigen
• lt 4 ng/ml normal
• 4 20 ng/ml Grey Zone
• gt 20 ng/ml highly suspect of PCa

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Clinical Findings

• D. Prostate biopsy(??)
• golden standard
• E. Imaging
• TRUS, MRI, Bone scan

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Treatment

• 1. Localized disease
• (optimal form in great debating)
• Watchful waiting
• Radical prostatectomy(????????)
• Radiationexternal beam

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Treatment

• 2. Locally advanced/metastatic diseases
• Endocrine therapycomplete androgen blockade
  orchiectomy????antiandrogen agent (flutamide,
  ???) or LHRH agonist(???)
• Radiation

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Thanks for your attention!