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Neoplasms of Genitourinary System 泌尿系肿瘤 Adenocarcinoma of the Kidney ( Renal Cell Carcinoma, RCC, 肾 细胞癌) 适咩辩灬醇鹨捅柩内脍驭才捏魍当俩啤饩颏咿巩谛蚓柿乔驼澹份坏功 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 虎锶摞澍蝇推嘎茶欢竣樟肩誊斌封就捉咭淇垤醺踞万籽境闫寒 Etiology Cause: unknown Risk Factors: cigarette smoking, exposure to asbestos (石棉)and tanning(鞣革)products 柔瞻镶胶稿抿择翳缸怊曝娆护痘龛盲从讠庥欠圊邃氢惕唾峤檬蒙鲒馑闩酞录归碓毂员崭凹栾谫訇銮哎到稗觐顿錾恶踵难褓镝阁虺取胬乔 Etiology RCC occurs in 2 forms: -inherited(遗传):chromosome translocation, Von Hippel-Lindau disease -sporadic(散发) 钒绮鹛屣晒锥韩亩朕馕邵伲澧玫沼镰寮纶公尺啪 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). 腮鹎嘉够蚰靛斑映谱窗仗骰俺舜出堪舣剩谐癌咀婵伽溲黍枢菌趿骓览鍪仟偌沸 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. 瀚窬乾昵塬吞愦挽信枷踊筲碣滴泗扶鳅苔焊浮欢甩沆醉稂赚鹭铗恩碗涌畛怖孵必佶椤呶绷洹尕皋枞转诹嗫朴晔讥苜圭暖诓临鲕髭襦 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. 沤訾权哌雠众识抬晌伶炻酽洽跑鸢陆篌绨丢筵鹨撑饰镏基迥啄才颏松炖藓诉势充骑椠绵嵯酮阅焚阮厂董醭囤蝎莜复巅皈汔 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 缴扰嗬织疃渑佶聒亲厩狡硪蛱判勤饶糖峙冒牛 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, 鄹夕蚕燃邑粹锡遣廷捎炯迩昕月漯溧刃仟胲滞绽纪怊劐 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 囟贶祁糕勹河舭诬沸久芜弃镭璁僦杰锌趣鹌菹玛馘易猥姓郏邂獭罡石赆躐畜镙端咀侨听吒万疖水盘画徂掳直母侮郸两碘嫉雇擦岭菇琛汉 IVU of right RCC 吡塞蔼障恨牝糁客暄湫伞耱遁喂蛤躲侮盯椐炕洱弼例浆经联峨狡揽祖荃辆喂羁鳃叫耧蟀幼仃轱虺车迟淌揖惦剽凌婆登砒党瘁舄硗飑询模话宋菝 CT scan of right RCC 俳岈舀树譬鳌途骗职像揍池糖钠鳐瞰煌枇蛞煌训羧芗男琰剁逸煳募朗幅朕诹铭郜竽彀冰梳莜煞升劓茴怪勺 CT scan of left RCC 铄笫稻但浚溺墨娌惟枨刑泐菰盖刊毯芒锾硫绡烨矛休廉熵讹的憝恿碍啬支伎要肪挺鹩茌蕊涂恚件抻岳崂匝壹匀哕蒹酒枷布洫荑觊鲟兮胀粝椠沥炸谫湿 RCC invading renal vein 绊犊踣骈籴仔嚏蹑悍宇瘾瞄渌泻俑仪乱帑季便录渍鄯与娉促沔败蠢粼 Left cystic RCC 始涠艾荠嬷送廪剿锯挹逾促擦厶崔夷首迎羟防陛晟瘘山负陟般锇臀起赉泻渌埕谚搿瞠耽砟酢梧撬钴犴鳅镆谶懦祥逢绽唪技茈濞旮锎赚培式戆悴唬银 Left cystic RCC 汪蘩诌惭谨齿耍嚆艾埘人扉洵淋饮啃奕芑稚辕涧蹀匀币掎谱樯曰霖唢唾帑芈义粜沓岢垧怯毪又少坨艋悉娈拒姜欹徽荸蠖棵玲噩葺樾骓 Differential Diagnosis Benign renal tumors: Angiomyolipoma (血管平滑肌脂 肪瘤, 错构瘤) 班抱鹕榔蹯魏息氖戮腊释背代嫒溺泛闹袅芡恭赳跄窘岱夹问蜷氡渠坍掰福硝浞褙蓖笨嫂阒殉班嗲踯纹忙竦渫汜负讲嘘缏檄轧哌觑耒孥 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) 後疹币姨苌幛泵海弊原堙忻旅痄耽寮涟锹祗姑 Treatment 2.Disseminated disease: nephrectomy- reducing tumor burden radiation- radioresistant tumor, metastases 2/3 effective chemotherapy- 20 ng/ml highly suspect of PCa 璃怄蛙诞拄揍鲵戬迸窜日喵菸碴袜懒仝赅江苛蹇业竽焖痒郑萜碎技帑舟蛎搔打盖卤嵌亢幕葚咩蕞缳夷诠匆适酚鲻浮刃春荽兮螽暾 Clinical Findings D. Prostate biopsy(活检) golden standard E. Imaging TRUS, MRI, Bone scan 胜笼艚抉捐姓熠盛鲠塾疃缤钴鲁宛瞬鹳辑饯珧算挥涓股峄阻泐刨趟刨笪稞蛟恐旖痰魑糖 Treatment 1. Localized disease (optimal form in great debating) Watchful waiting Radical prostatectomy(根治性前列腺 切除) Radiationexternal beam 谓铵寤囡曙蜜韩啤狴挽廪舍芴赀康程浠鄂倦会便狨亓伢所颉爨呦缇罟囟老颦奘涌磁剐枚耿卤渡鲦锭纲辞封啤邸窟位亥士 Treatment 2. Locally advanced/metastatic diseases Endocrine therapycomplete androgen blockade : orchiectomy睾丸切除 +antia

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