Transcript of Urology oncology
- 1. Genitourinary Tumors BY PROF/ GOUDA ELLABBAN
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- 5. RENAL CELL CARCINOMA (Hypernephroma,Adenocarcinoma) 85 % of
all primary kidney neoplasms 3% of all adult malignancies more than
40% of patients with RCC have died from their cancer The incidence
of RCC has increased since 1997( more prevalent use of
ultrasonography and CT scan for the evaluation of a variety of
abdominal or gastrointestinal complaints Male to femal ratio is 2:1
The tumor is not encapsulated Calcification is present in 7% of
cases
- 6. Etiology: Tobacco use has been incriminated as an etiologic
agent !!!!!!! Occupational and industrial carcinogens has no
relationship. Von Hippel-Lindau disease 30 % of pts have RCC ( 50%
metastatic) Often bilateral and multifocal In younger patients, M =
F Tuberous sclerosis Angiomyolipomas in 40-80% RCC Long-term
dialysis Developed cystic changes with associated carcinoma
Chromosome 3 Deletions and translocation involving short arm
Suppressor cancer gene
- 7. Clinical presentation: The classic triad of flank pain,
gross hematuria, and palpable abdominal mass is now rarely found
Hematuria ( micro, gross) in 60% Flank Or Abdominal pain in 50%
Palpable mass in 30-40% more than 50% of RCCs are now detected
incidentally Paraneoplastic syndromes in 20% of patients with RCC
Hepatic dysfunction Fever Hypertionsion ( renin production)
Hypercalcemia (PTH-like protien) Erethrocytosis (Erythropoiten)
Symptoms secondary to metastasis
- 8. Investigation: Plain X-ray Enlarged kidney shadow IVP A
space-occupying lesion ( calyceal distortion) Ultrasonography An
echogenic mass in the renal parenchyma Ct scan A mass with an
attenuation density value of +30 to +70 hounsfield MRI, Renal
arteriography
- 9. In general, any renal mass that enhances with intravenous
contrast on CT scanning should be considered a renal cell carcinoma
(RCC) until proved otherwise Figure 751. A, Computed tomographic
(CT) scan without contrast shows solid, left upper pole renal mass
measuring 31 Hounsfield units. B, After contrast administration, CT
scan shows that the mass enhances to 58 Hounsfield units. This mass
was excised and found to be a renal cell carcinoma
- 10. Renal pseudotumors may be due to a hypertrophied column of
Bertin, renal dysmorphism, or an unusually shaped kidney. In this
situation, the diagnosis of a pseudotumor can be confirmed by
isotope renography with technetium dimercaptosuccinic acid or
glucoheptonate Figure 752. A, Computed tomographic scan with
contrast shows isodense hilar mass in solitary right kidney. B,
Right renal arteriography shows no neovascularity. C,
Glucoheptonate isotope renal scan shows increased density of mass
indicative of hypertrophied column of Bertin. Copyright
- 11. approximately 20% to 25% of RCCs are angiographically
avascular Fine-needle aspiration or biopsy is of limited value in
the evaluation of renal masses high incidence of false-negative
biopsies in patients with renal malignancy The primary indication
for needle aspiration or biopsy of a renal mass is when a renal
abscess or infected cyst is suspected or when RCC must be
differentiated from metastatic malignancy or renal lymphoma.
- 12. Figure 754. Bosniaks class II cysts. A, Computed
tomographic (CT) scan without contrast shows calcium in wall of
right renal cyst. B, CT scan with contrast in another patient shows
right renal cyst with thin internal septation.
- 13. Figure 755. Bosniaks class II hyperdense cyst. A, Computed
tomographic (CT) scan without contrast shows small, smooth-walled,
high-density right renal cyst. B, CT scan after contrast
administration shows no enhancement of the cyst.
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- 20. Treatments: Radical nephrectomy Laparoscopic Radical
nephrectomy ***** Nephron sparing surgery A solitory metastatic
focus in the lung is locally excised Immunotherapy Interferon &
interleukin-2 for metastases Renal cell ca is radio-resistant,
&chemo-resistant
- 21. CARCINOMA OF THE RENAL PELVIS, CALYCES AND URETER
Urothelial tumors arise from the epithelial lining of the urinary
tract (calyces, renal pelvis, ureter and urinary bladder) Incidence
Pelvic tumors account for 7% of renal tumors, and 5% of urothelial
tumors. Pelvic tumors: ureteric tumors = 4:1 Male: female ratio =
2.1 Peak age incidence: 65 years
- 22. Etiology Smoking Chronic infection Abuse of analgesic
medications ( phenacetin) Occupational and industrial carcinogens
has relationship. Pathology Transitional cell carcinoma (TCC) (95%)
Squamous cell carcinoma (about 5%) Chronic bilharzial ureteritis
Recurrent calcular disease Adenocarcinoma: very rare (< 1%)
- 23. Metastases: Direct extension Mucosal extension (seeding)
Lymphatic extension Vascular extension Staging: Stage 0: confined
to the urothelium Stage A: suburothelial invasion Stage B: muscle
invasion Stage C: peri-ureteral fat invasion Stage D: invasion of
adjacent organs, lymph nodes Clinical findings Symptoms: total
painless hematuria is the most common
- 24. Investigations: Intravenous urography Urine cytology
Cystoscopy & ureteroscopy Treatment: Nephro-ureterectomy
(simple nephrectomy + ipsilateral ureterectomy)
- 25. CARCINOMA OF THE URINARY BLADDER Incidence The commonest
neoplasm affecting the urinary tract. Male: female ratio = 3:1
Etiology 1. Chronic bilharzial cystitis 2. Cigarette smoking 3.
Occupational exposure 4. Ectopia vesicae: rare.
- 26. Staging: Stage 0 :tumor confined to urothelium Stage A
:suburothelial invasion Stage B1 :superficial muscle invasion Stage
B2 :deep muscle invasion Stage C :perivesical fat invasion Stage D1
: invasion of adjacent pelvic organs Stage D2 : distant
metastases.
- 27. Methods of Staging: Bimanual examination of the bladder
under anasthesia Ultrasonography Transurethral biopsy CT scan Chest
X-ray Liver function test
- 28. Pathology: Transitional cell carcinoma(TCC) 90% Squamous
cell carcinoma 2-15% Adenocarcinoma 0.5-2% Grading: Grade 1 :
well-differentiated Grade 2 : moderately-differentiated Grade 3 :
poorly-differentiated
- 29. Clinical presentation: Total painless hematuria Burning and
frequency Obstructive urinary symptoms Hydronephrosis renal pain
Investigations: Urine cytology IVP Cystoscopy
- 30. Treatments: stages 0 and A papillary tumors: Transurethral
resection of the tumor Intravesical immunotherapy Follow-up
cystoscopy carcinoma in situ: Transurethral resection and
fulguration, BCG therapy Radical cystectomy !!!!! Stage B tumors
and beyond: Radical cystectomy Stage C & D Radiotherapy
Chemotherapy
- 31. Prostate cancer Rare before the age of 50 Hereditary
factors Tumor staging Stage A: no palpable lesion by DRE. A1: focal
A2: diffuse Stage B B1: small, discrete nodules B2: large, or
multiple nodules Stage C C1: seminal vesicles not involved;
tumor