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Neoplasms of Genitourinary System泌尿系肿瘤,瑞金医院泌尿外科 邵 远,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 5th6th 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 Gerotas 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 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,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 Gerotas fascia including ipsilateral adrenal, proximal 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 88100% II 60% III 1520% IV 020%,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 7090% flank pain 850% 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 8590% irritative voiding symptoms B. Signs: Majority of patients have no pertinent physical signs.,Clinical Findings,C. Lab tests: urine testhematuria urinary cytologydepend on grade and volume of the tumor other markers: BTA, NMP22, telomerase(端粒酶),Clinical Findings,D. Imaging: Ultrasonographyscreen IVUevaluation of upper urinary tract CT/MRIassessment 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 3978% Thiotepa 189 up to 55% Doxorubicin 580 mean 38% BCG 3671%,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 diseaseobstructive or irritative voiding complaints, bone pain, paresthesias(感觉异常)and weakness of lower extremities B. Signs: DREinduration(硬结),Clinical Findings,C. Tumor markers PSA(前列腺特异抗原)Prostate
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