tumor of urology
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GENITOURINARY CANCER
Urology Division, Surgery Department
Medical Faculty,
University of Sumatera Utara
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BENIGN TUMORS
Adenoma
Oncocytoma
Angiomyolipoma Leiomyoma
Lipoma
Hemangioma
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1. Renal adenoma
The most common benign renal parenchymal
lesion
Small, well-diff glandular tumors of the
renal cortex Asymptomatic
Should be treated of an early renal cancer
and the patient should be evaluated andtreated appropriately
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2. Renal oncocytoma
3 5% of renal tumor, := 2 : 1
Gross hematuria & flank pain in < 20%
Radical nephrectomyis the safest method of
treatment unless other factors argue for aconservative approach
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3. Angiomyolipoma (Renal hamartoma)
Composed of fat, muscle & blood vessels
Rare, 4 : 1
Acute flank pain or shock due to spontaneous
renal or retroperitoneal hemorrhage
Asymptomatic tumors < 4 cm followed
closely with serial imaging
Symptomatic tumors or > 4 cm selectiveembolization or tumor enucleation by partial
nephrectomy
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RENAL PARENCHYMAL TUMORS
The most common type of renal tumor is
renal cell carcinoma
80 85% of all renal cancers
Survival is based on tumor stage
Other types of kidney tumors include
metastatic lesions, sarcomas,
juxtaglomerular tumors and lymphomas
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ADENOCARCINOMA OF THE KIDNEY
(RENAL CELL CARCINOMA)
3% of adult cancer
:= 2 : 1, 5th6thdecades of life
racial distribution is equal
more common in urban settings
= hypernephroma = clear cell carcinoma =alveolar carcinoma
Etiology is unknwon Risk factor : Cigarret smoking strongest
Obesity
Acquired renal cystic disease
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GRADING & STAGING
Fuhrman system (I IV)most often used
General classification system :
- Robson system
- TNM system
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CLINICAL PRESENTATION
Symptom & sign
Classic triad: hematuria
flank pain
palpable mass
General symptom : weight loss, fever,
anemia, night sweats
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Presenting symptoms associated with theprimary tumor :
- hematuria
- mass - typically appreciated with lowerpole masses in thin patients
- varicocele : typically on left side, will not
decompress when patient is supine
- edema, and lower extremity varices
associated with vena cava obstruction
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Presenting symptoms associated with metastases :
- bone pain
- neurological symptom
- ascites Paraneoplastic syndrome
- erythrocytosis (1 5%)
- hypercalcemia
- hepatic dysfunction
- amyloidosis
- anemia
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Initial evaluation
Physical examination
Laboratory studies
- CBC
- serum electrolytes
- LFT
Imaging for staging
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IMAGING EVALUATION
Intravenous excretory urography
Renal sonography
CT
MRI
Angiography
Radionuclide imaging
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TREATMENT FOR LOCALIZED DISEASE
Radical nephrectomy is gold standard
Partial nephrectomy
Energy ablative techniques
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TREATMENT FOR METASTATIC RCC
30% of newly diagnosed cases of RCC aremetastatic
Associated with extremely poor survival
Common sites : lung, bone, liver, brain, ipsilateral
or contralateral kidney Generally chemotherapy-resistant
Disseminated disease
- surgery
- radiation therapy- hormonal therapy
- radioimmunotherapy
- biologic response modifier
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PROGNOSIS
related to the stage at presentation 5-yr survival rate for T1 88 100%
T2 & T3a 60%
T3b 1520%
with metastatic 0 20%
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NEPHROBLASTOMA (WILMS TUMOR)
The most common solid renal tumor of
childhood; 5% of childhood cancer
3rdyear of life, no sex predilection
Commonly unicentric, occur in either kidneywith equal frequency
Metastatic is present at diagnosis in 10
15%, with lungs (85-95%) and liver (10-15%)the most common sites
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Clinical findings
present with palpable abdominal mass,
smooth and rarely crossing midline
Abdominal pain, anorexia, nausea &vomiting, fever, hematuria
Hypertension (25-60%)
DD : hydronephrosis
cystic kidneys
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treatment
Surgical
Radiation
- radiosensitive
- its use complicated by potential growthdisturbances, recognized cardiac, pulmonary &
hepatic toxicities
Chemotherapy
- chemosensitive neoplasm- actinomycin D, vincristine, doxorubucin,
cyclophosphamide, etoposide, cisplatin
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SARCOMA OF THE KIDNEY
Rare, 1-3% of all malignant renal neoplasm
5thdecade, alight male predominance
Flank or abdominal pain, weight loss
Leiomyosarcoma (50%), fibrosarcoma,
liposarcoma,hemangiopericytomas,
osteogenic sarcoma, malignant schwannomas
Radical nephrectomy for localized disease
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LYMPHOMA
Primary renal lymphoma are extremely rare
Kidney may be involved by either direct
extension or hematogenous spread
Suspect lymphoma if the mass appearsinfiltrating or multifocal, there is diffuse
adenopathy
Biopsy warranted if lymphoma suspected
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etiologi
Industrial carcinogens aniline dyes, naphtylamin
Tobacco exposure
Chemotherapeutic agent
Schistosomiasis
Pelvic irradiation
Chronic irritation & infection
Phenacetin
Baldder exstrophy
Coffee not strong
Saccharinin experimental animal
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Epidemiology
Age 6th8thdecades
Race twice in American men
Gender: = 3 : 1 Genetics
Demographyhigher in US compared to
Japan
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Symptom
Gross, painless hematuria
- most common (85% cases)
- intermittence is not a reason to exclude an
evaluation- indicates cancer until proven otherwise
Irritative voiding symptom frequency,dysuria, urgency (frequently associated with
CIS) Bladder filling defect on urography
Unanticipated finding on cystoscopy
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Diagnosis
History & physical examination
Urine culture
Urine cytology
highly specific Flow cytometry
Tumor markers
Upper tract imaging
Cystoscopy
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Pathology
Epithelial dysplasia
Carcinoma in situ
Superficial TCC 70%
Muscle invasive TCC
Squamous cell ca
Adenoca
Sarcoma of the bladder
Small cell carcinoma
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treatment
Superficial bladder cancer
1. TURBT - initial & standard therapy
2. Laser photocoagulation less dyscomfort,
minimal bleeding
3. Intravesical therapy
- weekly treatment
- mitomycin C, adriamycin, thiotepa, BCG, interferons
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Muscle invasive TCC
1. radical cystectomy
2. partial cystectomy
3. radiation therapy4. TUR
5. combined
6. adjuvant therapy7. metastatic disease MTX, vinblastine,
adriamycin
8. palliative therapy
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