泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件

1、泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGENITOURINARYTR泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件 Renal cell carcinoma Renal cell carcinoma (RCC) is the most common type of kidney cancer. These tumors occur twice as often in men as in women and usually occur in adults between the ages of 50 and 7

2、0. Between 25 and 30% of patients have metastases at the time of diagnosis. Renal cell carc Environmental risk factors include smoking , Phencetin-containing painkillers abused or over-used, some heavy metals exposure ( lead and cadmium). Other risk factors include long-term dialysis, overweight, a

3、high fat diet. Environmental risk factorThere are also hereditary risk factors. There are some genes mutations in rare syndromes like tuberous sclerosis and von Hippel Lindau Disease that are associated with an increased risk of developing kidney tumors. There are also hereditary risk Von Hipple-Lin

4、dau (VHL) disease is an autosomal dominant disorder in which affected individuals are at risk for retinal angiomas, central nervous system hemangioblastomas, renal cysts and carcinomas, pancreatic cysts and tumor, pheochromocytomas,endolymphatic sac tumors, and/or epididymal cystadenomas. Von Hipple

5、-Lindau (VHL) disTypes of renal cell carcinoma:Clear cell RCC (60 to 75 percent), papillary RCC (15 percent), chromophobe RCC (5 percent), collecting duct carcinoma (less than I percent), and unclassified carcinoma (up to 5 percent). Types of renal cell carcinoma:Clinical Presentation1. Renal cell c

6、arcinoma can become quite large without causing any symptoms. Many tumors are found incidentally. 2. Hematuria is the most common symptom. Other signs and symptoms include low back pain, a mass in the abdomen, Clinical Presentation1. Renal 3. General symptoms. fatigue, weight loss, fever, anemia, sw

7、elling of the legs and night sweats 4. Paraneoplastic syndromes. Hypercalcemia , Stauffers syndrome protein-wasting enteropathy, erythrocytosis, neuromyopathy, and gonadotropin production. Amyloidosis is present in approximately 2 percent of patients. 3. General symptoms. fatiguThere are multiple im

8、aging studies, including intravenous pyelogram (IVP), ultra-sonography, computerized tomographic (CT) scans, magnetic resonance imaging (MRI) which can produce images of the kidney. There are multiple imaging stu泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGEN

9、ITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件 Arteriography and angiography can demostrate blood vessels and image the kidney. A chest x-ray is used to e

10、valuate the lungs metastases. A bone scan can identify cancer in bone. Arteriography and angiogra泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件Staging of Renal Cell Carcinoma Stage cancer is confined to the kidney, Stage means the cancer has broken through the kidney capsule and has spread into adjacent tissue

11、, Stage indicates that it may have spread further into lymph nodes or blood vessels, Stage indicates that it is more wide-spread, particularly in other organs Staging of Renal Cell Carcinom泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件TreatmentRadical nephrectomy is the gold standard treatment for localized RC

12、C. Components of a radical nephrectomy include early vascular ligation and en bloc removal of the kidney, Gerotas fascia, ipsilateral adrenal, upper ureter, and, for some, lymph nodes from the crus of the diaphragm to the aortic bifurcation. TreatmentRadical nephrecto Laparoscopic radical nephrectom

13、y Nephron sparing surgery Absolute indications: include a solitary kidney, bilateral tumors, poor bilateral or contralateral renal function. Relative indications: smaller tumors (4 cm or smaller) with a normal contralateral kidney.Approaches include segmental polar nephrectomy, wedge resection, or t

14、umor enucleation Laparoscopic radical nephrect Imunotherapy: Interferon alpha provides a 15 percent partial response rate and I percent CR. lnterleukin-2. The only drug approved by the FDA specifically for metastatic carcinoma. A partial response rate of 14 percent with 5 percent CR. Continuous infu

15、sion or subcutaneous injections are less toxic. Chemotherapy Radiation therapy Imunotherapy: Interferon alNEPHROBLASTOMA ( Wilms Tumor )NEPHROBLASTOMA ( Wilms TumorWilms tumor, is exclusively a disease of children under age 4 years. It is a highly malignant mixed tumor consisting of tissues of conne

16、ctive tissue origin and epithelial structures. Wilms tumor, is exclusively It is usually discovered as a palpable mass by the mother or by an examining physician. Treatment of the primary tumor is radical nephrectomy. Adjunctive therapy with irradiation and chemotherapy is important in improving sur

17、vival. It is usually discovered TUMOR OF THE RENAL PELVISTUMOR OF THE RENAL PELVIS The transitional epithelium of the renal pelvis may arise to malignant tumors that are similar to lesion that occur in the bladder. Hematuria is the most commonly the presenting complain. Intravenous urography and ret

18、rograde urography can show the filling defect. The transitional epithelium泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件 Treatment Nephroureterectomy The classic therapy for upper tract TCC is nephroureterectomy with excision of a bladder cuff. Laparoscopic nephrourectomy Tre

19、atmentBLADDER CANCERBLADDER CANCER Bladder cancer is the most common urologic malignancy The most common histologic diagnosis is transitional cell carcinoma (TCC). Sixty to 75 percent of these lesions are noninvasive, superficial tumors, but 10 to 20 percent of these tumors will progress to muscle-i

20、nvasive disease, especially patients with high-grade disease and transitional cell carcinoma in situ. Bladder cancer is the most Several factors are associated with the development of bladder cancer.1.Occupational exposure to chemicals is thought to cause the disease. 2.Smoking is also related to de

21、veloping bladder cancer. The risk of developing the disease in smoking is four times that in non-smoking. 3.Chronic cystitis and bladder stone can cause squamous cell carcinoma.Several factors are associatedPathologyTypes of bladder tumor: transitional cell carcinoma, squamous cell carcinoma, adenoc

22、arcinoma, and others. More than 95% primary bladder carcinomas are transitional cell carcinoma. Squamous cell carcinoma and adenocarcinoma account for approximately 2-3% respectively. Adenocarcinoma may arise from an urachal remnant at the dome of the bladder or from submucosal gland in the vicinity

23、 of the bladder neck.PathologyTypes of bladder tumGradeThe grade is based on the degree of cellular differentiationgradebeing well differentiation, and grade being moderate differentiationgrade being poorly differentiation. GradeThe grade is based on thStageThe stage of Bladder carcinoma includes tu

24、mor in situ (Tis), papillary tumor confined to mucosa (Ta), invades submucosa only (T1), invades superficial muscle (T2), invades deep muscle (T3), spreads beyond the bladder, including into the prostate or other organs (T4). StageThe stage of Bladder car泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件 Transitio

25、nal cell carcinoma has three features: multiple lesions in bladder, multiple organs (pelvis, ureter, and post urethral can develop transitional cell carcinoma at same time.), recurrence (more than 50% patient will recur after the operations). Transitional cell carcinomLocation of Bladder TumorMost a

26、re located on lateral and posterior wall of bladder, then on the top and the triangle.Location of Bladder TumorMost泌尿生殖道肿瘤TUMORSOFGENITOURINARYTRACT课件Transitional cell carcinoma of the bladder develops more frequently in men than in women, and its frequency increases with age. The Prognosis is poor

27、for aging patient and female. Carcinoma of bladder is quite rare in children.Transitional cell carcinoma of Clinical presentations Hematuria. Either gross or microscopic hematuria is present in 85 percent of cases. The amount of hematuria is not necessarily proportional to the severity of the lesion

28、, and intermittence is not a reason to exclude an evaluation. Hematuria in older patients may result in the diagnosis of a urologic malignancy in 10 percent of patients, with the majority of these lesions being TCC. Clinical presentations Microscopic or gross hematuria indicates cancer until proven

29、otherwise and must be evaluated. Irritative voiding symptoms. Increased frequency of urination, dysuria, and urgency may be present in up to 20 percent of patients with bladder cancer, particularly CIS. Microscopic or gross hematDiagnosis1.The diagnosis is established by cystoscopy and biopsy of the

30、 tumor. 2.Urinary cytological test may be used to find the cancer cell. 3.Intravenous urography is essential for the bladder carcinoma. 4.Ultrasound, CT scan, and MRI detect the tumor in bladder, especially for the tumor stage.Diagnosis1.The diagnosis is eTreatmentSuperficial bladder tumors (Ta and

31、T1) are often amenable to transurethral resection or transurethral coagulation of laser.Invasive bladder tumors (T2 and T3) may require partial cystotectomy, or radical cystotectomy. TreatmentSuperficial bladder Systemic chemotherapy with multiple drug regimens incorporating cisplatin has shown prom

32、ise for the advanced disease.Intravesical chemotherapy may be effective in controlling superficial disease but is ineffective for treatment of invasive lesion. Systemic chemotherapy with mulThe most effective agent is bacillus Calmette-Guerin (BCG) intravesical immunotherapy, which decreases tumor r

33、ecurrence by 40 to 70 percent. In the case of transitional cell carcinoma in situ (CIS), it may reduce tumor progression.The most effective agent is bAfter treatment of the superficial tumor, periodic cystoscopy and urinary cytological examination is necessary for at least 5 years. New tumors may al

34、so be well controlled by transurethral means, but if they tend to recur they apt to become progressively invasive and of higher grade. Cystectomy must then be considered.After treatment of the superfiPROSTATE CARCINOMAPROSTATE CARCINOMA Prostate carcinoma is the most common malignance in the West co

35、untries, and the second death after lung cancer. Although the incidence of prostate carcinoma is low in China and eastern countries, remarkable increase has been found recently. Prostate carcinoma is the mos It occurs predominantly in old men. It has the capacity to grow and invade locally and to me

36、tastasize by blood and lymph. There is a strong predilection for metastases to bone, and these metastases have the unique characteristic of being osteoblastic. It occurs predominantly in Prostate cancer has few dramatic primary signs or symptoms. It can be associated with urinary obstructive symptom

37、s or hematuria, although these findings are usually due to other causes. Bone pain can unfortunately be an initial symptom, but it represents very advanced disease. Prostate cancer has few draDiagnosis1. digital rectal examination, 2. prostate specific antigen,3. transrectal ultrasound exam, 4. biop

38、sy,5. bone scan, and so on.Diagnosis1. digital rectal exAndrogen blockade is the best method for the treatment of advanced prostate carcinoma.Radical prostatectomy and Radiation can be used for early stage patient.Androgen blockade is the bestTESTICULAR TUMORSTESTICULAR TUMORSTestis tumors most commonly occur in men between 18 and 35 years of age. Tumors arising from the Leydigs cell and Sertolis cells are rarely seen. Most of the testis tumors arise from the germinal epithelium, and all of these tumors should be considered malignant except for teratomas that occur before pu