Tumor of Urology

8/11/2019 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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