k12 Bedah Genitourinary Cancer

8/16/2019 k12 Bedah Genitourinary Cancer

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I. RENAL TUMORS

A. Grawitz Tumor

B. Wilms Tumor

ll. UPPER URINARY TRACT.TUMORS(P l!io"#al$# s s$st m %Ur t r&

III. BLA''ER TUMORS

I . TESTICULAR TUMORS

. PROSTATE CANCER

I. PENILE CANCER


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RENALTUMORS


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A. Simplifed classifcation o renal tumors:Benign tumors cystic lesion, oncocytoma,

angiomyolipoma (AML)

Malignant :

- Nep ro!lastoma ("ilms# tumor)

- $enal %ell %a (adenocarcinoma, & ypernep roma')

B. $enal masses classifed !y pat ology o $enal umors


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c. $enal masses classifed !y radiograp ic

appearance

Simple cyst

%omple cyst

*atty tumors (AML)

All ot ers:

- +ncocytoma

- $enal cell ca ect.


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A !enign renal neoplasmt is composed o aria!le amounts o at,ascular, and smoot muscle elements

e at density o t e tumour on % as !eenregarded to !e pat ognomonic

t occurs in more t an /0 o indi iduals 1ittu!erous sclerosis, o ten !ilaterally.Angiomyolipomata also occur in 2/0 o 1omen1 o a e a rare, cystic lung disease calledlymp angioleiomyomatosis, or LAM .


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umor 3 2 cm can !e o!ser ed

Nep rectomy in patients 1it acute or

potentially li e-t reatening emorr age

Selecti e em!oli4ation in patients 1it

!ilateral disease


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5 60 o all adult malignanciesMale: *emale: 6 : 78 t and 9 t decade o li e, uncommon in c ild ood$enal cell carcinoma arise rom t e renalepit elium and account or a!out percent orenal cancers

A ;uarter o t e patients present 1it ad anceddisease, (m$%%)A t ird o t e patients 1 o undergo resection olocali4ed disease 1ill a e a recurrence


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T " Primar$ tumour < =rimary tumour cannot !e assessed / No e idence o primary tumour > umour 3 9 cm, limited to t e ?idney- >a umour 3 2 cm.

- >! umour @ 2 cm !ut 3 9 cm 7 umour @ 9 cm 6 umour e tends into ma or eins or adrenal gland or

perinep ric tissues !ut not !eyond erota#s ascia- 6a umour directly in ades adrenal gland or perinep ric

tissues> !ut not !eyond erota#s ascia- 6! umour e tends into renal ein, or t e ena ca a

!elo1 t e diap ragm- 6c umour e tends into ena ca a a!o e diap ragm

2 umour directly in ades !eyond erota#s ascia

RENAL CELL CARCINOMA


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N " R )io*al l$m+, *o- sN< $egional lymp nodes cannot !e assessedN/ No regional lymp node metastasisN> Metastasis in a single regional lymp nodeN7 Metastasis in more t an > regional lymp nodepN/ lymp adenectomy or more lymp nodes arenegati e.

M " 'ista*t m tastasis

M< Cistant metastasis cannot !e assessedM/ No distant metastasisM> Cistant metastasis



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TNM sta) )rou+i*)

Stage > N/ M/Stage 7 N/ M/Stage 6 N/ M/

>, 7, 6 N> M/Stage D 2 N/,N> M/

Any N7 M/ Any Any N M>



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ncidental fndings on ES

S$m+toms : - Fematuria

- *lan? pain

- A!dominalGHan? mass

+t ers: Daricocelle G Lo1er e tremity oedema

Para"* o+lasti# s$m+toms :ncreased LIC G LCF G %aJ

Ene plained e er


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ErinalysisA!dominalGpel ic ultrasound G % or M$ 1itor 1it out contrast depending on renal

unction% est imagingBone scan, i clinically indicatedBrain M$ , i clinically indicated

urot elial carcinoma suspected, considerurine cytology, E$S or retrograde

pyelography %onsider needle !iopsy, i clinically indicated


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Cl ar # ll #o*! *tio*al /0 "

102

=apillary >/ - > 0

% romop o!ic 2 - 0

%ollecting duct 3 >0

Medullary cell 3 >0

+ncocytoma 6 - 90


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Tr atm *t 3

Nep ron-sparing surgery

$adical Nep rectomy

% emot erapi

mmunot erapi


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Lung 7K 2 0

Bone >8 - 79 0Li er 7 - >/ 0

Brain > 9 0


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A!out 5 -90 o all renal tumors402 ar TCC , K0 s;uamous cell ca

%% o t e renal pel is is 6-2 times more re;uentt an %% o t e ureter

: 6-2 : >ncidence increases 1it age, pea?s during 8 t -

9 t decades/0 o ureteral tumors are multicentric -years o erall sur i al rate is signifcantly

related to tumor stage


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Ris5 6a#tors 3% ronic in ection

Long standing stoneAnalgesic a!use

Smo?ing

+ccupation (c emical, petroleum, plastic, coal,asp alt)

I posure to cyclop osp amide (al?ylatingagent)


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'ia)*osti# 3

Fistory : ematuria, painGcolic

Erine cytology

maging : EBG DE, % Scan

Indoscopy : $= , %ystoscopy, E$S (!iopsy prn)

Staging : % est


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Ereterectomy (resection O anastomosis) inselected cases 1 ene er possi!le

Nep ro-ureterectomy

Indoscopic management

nstilation t erapy


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Most common malignancy o t e urinary tract

Male @ *emale

9 - 0 o patients 1it !ladder cancer present

1it disease confned to t e mucosa

e a erage age at diagnosis is 8 years


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Aromatic amines

Smo?ing

rauma to t e urot elium induced !y in ection,

instrumentation, and calculi

enetic


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%% K/ 0S%% >/ 0Adeno %a 7 0Sarcoma

=EN LM=EndiPerentiatedEn?no1n

BLADDER CANCER


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T " Primar$ tumour < =rimary tumour cannot !e assessed / No e idence o primary tumour

a Non-in asi e papillary carcinoma is %arcinoma in situ: QHat tumour#

> umour in ades su!epit elial connecti e tissue 7 umour in ades muscle 7a umour in ades superfcial muscle (inner al )

7! umour in ades deep muscle (outer al ) 6 umour in ades peri esical tissue: 6a Microscopically

6! Macroscopically (e tra esical mass) 2 umour in ades : prostate, uterus, agina, pel ic 1all,a!dominal 1all

2a umour in ades prostate, uterus or agina 2! umour in ades pel ic 1all or a!dominal 1all

BLADDER CANCER

BLADDER CANCER


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N " L$m+, *o- sN< $egional lymp nodes cannot !e assessedN/ No regional lymp node metastasisN> Metastasis in a single lymp node 7 cm or less

in greatest dimensionN7 Metastasis in a single lymp node more t an 7

cm !ut not more t an cm in greatestdimension, or multiple lymp nodes, none moret an cm in greatest dimension

N6 Metastasis in a lymp node more t an cm ingreatest dimension

BLADDER CANCER

BLADDER CANCER


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M " 'ista*t m tastasisM< Cistant metastasis cannot !e assessedM/ No distant metastasisM> Cistant metastasis

BLADDER CANCER


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S$m+toms : Fematuria K/ 0

Cysuria, re;uency, urgency

'ia)*osis :

Erine cytologymaging: ES G EB O DE G % -S%AN

%ystoscopyG E$ O !iopsy :

- umor si4e

- Location G single or multiple

- umor !ase !iopsy


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Bas - o* 3

umor typeGgradeGstageGsi4e

=rimaryGrecurrence

Location

*ocality

%o-mor!idity


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ntra esical % emot erapi

ransuret tral $esection o Baldder umor

$adical %ystectomi

$adiot erapi

% emot erapi


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k12 Bedah Genitourinary Cancer

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