U rogenital Neoplasms
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Transcript of U rogenital Neoplasms
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Urogenital Neoplasms
Liping Xie
Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University
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Renal Cell Carcinoma (RCC)
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• RCC accounts for 2% to 3% of all adult malignant , 85% of all primary malignant renal tumors, is the most lethal of the urologic cancers
• Renal cell carcinoma (RCC) affects 38,000 individuals in the U.S. yearly, and 11,900 patients die of this disease
• RCC occurs most commonly in 5th~6th decade, male-female ratio 1.6:1
Renal Cell Carcinoma (RCC)
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Etiology
Renal Cell Carcinoma (RCC)
• Majority of RCC occurs sporadically• Tobacco smoking contributes to 24-30% of RCC cases
- Tobacco results in a 2-fold increased risk • Occupational exposure to cadmium, asbestos, petroleum• Obesity• Chronic phenacetin or aspirin use • Acquired polycystic kidney disease due to dialysis results
in 30% increase risk
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• 2-4% of RCC associated with inherited disorder * Von Hippel-Lindau disease
- familial cancer syndrome of retinal angiomas, CNS hemangioblastomas, pheochromocytomas and clear cell RCC.
* Hereditary papillary renal cancer
- Multiple, bilateral papillary renal tumors , C-met oncogene on ch 7
* Birt-Hogg-Duke syndrome
- Fibrofolliculomas, lung cysts, and RCC, Mutation in BHD gene ch 17p
Renal Cell Carcinoma (RCC)
Etiology
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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.
Renal Cell Carcinoma (RCC)
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Clinical Findings
Symptoms & Signs Renal tumors are increasingly detected incidentally
by CT or ultrasound
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 Cell Carcinoma (RCC)
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Clinical Findings
B. Paraneoplastic Syndromes• Erythrocytosis, hypercalcemia, hypertension
C. Lab Findings• anemia, hematuria (60%), ESR↑
Renal Cell Carcinoma (RCC)
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Clinical Findings
B. Paraneoplastic Syndromes• Erythrocytosis, hypercalcemia, hypertension
C. Lab Findings• anemia, hematuria (60%), ESR↑
Renal Cell Carcinoma (RCC)
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Clinical Findings
D. Imaging• Ultrasonography• Intravenous Urography (IVU): • CT scanning: more sensitive, mass+renal
hilum, perinephric space and vena cava, adrenals, regional LN and adjacent organs
• Renal Angiography• MRI: to evaluate collecting system and IVC
involvement
Renal Cell Carcinoma (RCC)
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Diagnosis
• No screening for the general population• No bio-marker available• Radiographic evaluation
Renal Cell Carcinoma (RCC)
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IVU of right RCC
Renal Cell Carcinoma (RCC)
CT Scan of Left RCC
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Renal Cell Carcinoma (RCC)
RCC invading renal vein
Righ Cystic RCC
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CT scan with 3D reconstruction
Renal Cell Carcinoma (RCC)
Neovascularity in Renal Angiography
associated with RCC
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A, Magnetic resonance scan of kidneys without administration of gadolinium suggests anterior right
renal mass.
B, After intravenous administration of gadolinium-labeled
diethylenetriaminepentaacetic acid, MRI shows enhancement of this mass
indicative of malignancy.
Renal Cell Carcinoma (RCC)
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Tissue Diagnosis
• Tissue diagnosis obtained from nephrectomy or biopsy
Renal Cell Carcinoma (RCC)
Papillary (chromophilic) renal cell carcinoma extending into the collecting
system with histological findings
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Tumor Staging (Robson System)
Renal Cell Carcinoma (RCC)
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Tumor Staging (International TNM Staging System)
Renal Cell Carcinoma (RCC)
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Tumor Staging
Renal Cell Carcinoma (RCC)
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Differential Diagnosis
• Benign renal tumors
-Angiomyolipoma
Renal Cell Carcinoma (RCC)
• Renal Pelvis Cancer
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Treatment
A. Localized disease:• Surgical removal---only potentially curative therapy
• Radical Nephrectomy (en bloc removal of the kidney and Gerota’s fascia including ipsilateral adrenal, proximal ureter, regional lymphadenectomy
Renal Cell Carcinoma (RCC)
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Renal Cell Carcinoma (RCC)
Laparoscopic Radical NephrectomyHand-Assisted Laparoscopic
Radical Nephrectomy
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TreatmentA. Localized disease:• Partial Nephrectomy(nephron-sparing surgery, NSS )
--polar tumor
--tumor size<4cm
--bilateral RCC
--solitary kidney
Renal Cell Carcinoma (RCC)
Laparoscopic NSS
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TreatmentA. Localized disease:• Percutaneous/
Laparoscopic Radiofrequency Ablation or Cryoablation
Renal Cell Carcinoma (RCC)
Laparoscopic Cryoablation
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Treatment
B. Disseminated disease:• nephrectomy--- reducing tumor burden• radiation--- radioresistant tumor, metastases 2/3
effective• chemotherapy--- <10% effective• immunotherapy--- IL-2/interferon-alpha, 30% response
rate• molecular therapy---eg. sorafenib
Renal Cell Carcinoma (RCC)
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Prognosis
• Stage 5-year survival rate • I 88~100%• II 60%• III 15~20%• IV 0~20%
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Bladder Cancer
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The second most common cancer of the genitourinary system (most common in China)
The male-female is 2.7:1
The peak incidence is in persons from 50-70 years
Bladder Cancer
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Industrial toxins Cigarette smoking Genetic events Other risk factors
cyclophosphamide, alkylating agents,
radiotherapy of pelvis.
Bladder Cancer
Etiology
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Pathology
Histopathlogy 1.transitional cell carcinoma 90% 2.squamous cell carcinoma 7-8% 3.adenocarcinoma 1-2% 4.other types Grading Grade 1 mild anaplasia Grade 2 moderate anaplasia Grage 3 marked anaplasia
Bladder Cancer
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Clinical Findings
A. Symptoms:• Painless Hematuria 85~90%• Irritative voiding symptoms
B. Signs:• The majority of patients have no pertinent
physical signs.
Bladder Cancer
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Clinical Findings
C. Lab tests:• Urine test——hematuria• Urinary cytology——depend on grade and
volume of the tumor• Other markers: BTA, NMP22, telomerase
Bladder Cancer
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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
Bladder Cancer
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Diagnosis
Ultrasonography can be used as screening method to detect bladder tumors and upper urinary tract obstruction.
both CT and MRI are used to characterize the extent of bladder wall invasion and detect enlarged pelvic lymph node.
Bladder Cancer
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Diagnosis
Cystoscopy
the diagnosis of bladder cancer depends on cystoscopy.
cystoscopy can provide good information on the extent of the tumour.
suspicous areas can be biopsied.
Bladder Cancer
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Ultrasonography of Bladder Ca (Arrow Head)
Bladder Cancer
IVU of Bladder Tumor
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CT scan of bladder Ca
Bladder Cancer
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Bladder Cancer
Cystoscopy of bladder Ca
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Bladder Cancer
TNM Tumor Staging
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Bladder Cancer
TNM Tumor Staging
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Treatment Superficial bladder cancer (Ta,T1,Tis) transurethral resection intravesical chemotherapy or immnotherapy(BCG) cystoscopic surveillance
Bladder Cancer
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Treatment
Invasive bladder cancer (T2-T4) partial cyctectomy solitary, inflitrating tumors localized along the posterior lateral
wall or dome of the bladder. radical cystectomy 1.muscle-invasive bladder cancer T2-T4a, N0-NX, M0. 2.high-risk superficial
tumours (T1G3, BCG-resistant Tis) 3.extensive papillary disease Urinary diversion after radical cystectomy
Bladder Cancer
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partial cyctectomy
Bladder Cancer
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Bladder Cancer
Radical Cystectomy
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Treatment
Radiotherapy Modern 3D-radiotherapy is a reasonable treatment option in
patients who wish to preserve their bladder
Chemothery
chemothery for metastatic disease.
adjuvant chemotherapy
Neoadjuvant chemotherapy
Bladder Cancer
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Prostate Cancer
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• The most common cancer diagnosed and is the second leading cause of cancer death in American men
• the incidence of prostate cancer is continuously increasing each year in china
• The incidence increases with advancing age
Prostate Cancer
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Risk factor
• Age• Genetic influences
Race - African Americans are at a higher risk than whites
• Positive family history • High dietary fat intake • Hormonal factors
androgen dependence Others
Prostate Cancer
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Pathology
• Over 95% of the cancers of the prostate are adenocarcinomas.
• Prostatic intraepithelial neoplasia (PIN)
high grade (HGPIN)
low grade (LGPIN)
Prostate Cancer
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Prostate Cancer
Mostly arise from the peripheral zone of the
gland
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Grading
• the Gleason system is widely used for its best clinical correlation
Prostate Cancer
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Staging
Prostate Cancer
• Stage I small foci of carcinoma in resection for benign disease
• Stage II disease confined to prostate• Stage III extracapsular extension• Stage IV regional lymph node metastases or distant
metastases
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The TNM staging system
Prostate Cancer
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Clinical Findings
A. Symptoms• Early stage: asymptomatic• Locally advanced/metastatic disease—
obstructive or irritative voiding complaints, bone pain, paresthesias and weakness of lower extremities
Prostate Cancer
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Clinical Findings
B. Signs: • Digital rectal examination—induration
Prostate Cancer
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Clinical Findings
C. Tumor markers
Prostate Specific Antigen (PSA)
• < 4 ng/ml normal
• 4 ~ 10 ng/ml Grey Zone
• > 10 ng/ml highly suspect of PCa
Prostate Cancer
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Clinical Findings
D. Imaging• Ultrasonography - hypoechoic lesion
Transrectal ultrasonography (TRUS)• CT, MRI• Bone scan
Prostate Cancer
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Clinical Findings
E. Prostate biopsy• The golden standard
Prostate Cancer
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MRI of prostate cancer
Prostate Cancer
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Bone scan
Prostate Cancer
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Treatment
A. Localized disease• Watchful waiting, older patients with samll,
well-differentiated cancer• Radical prostatectomy, patients with a life
expectency > 10 years• Radiation
Prostate Cancer
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Radical ProstatectomyProstate Cancer
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Prostate Cancer
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Treatment
B. Locally advanced/metastatic diseases• Endocrine therapy—androgen blockade :
orchiectomy
antiandrogen agent
LHRH agonist• Radiation• Chemotherapy
Prostate Cancer
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Further Reading
Renal Pelvis Cancer / Tumor of Ureter
Penile Cancer
Testicular Cancer
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Further Reading
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Thank you for your attention !