k12 bedah genitourinary cancer
TRANSCRIPT
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I. RENAL TUMORS
A. Grawitz Tumor
B. Wilms Tumor
ll. UPPER URINARY TRACT.TUMORS(P l!io"#al$# s s$st m %Ur t r&
III. BLA''ER TUMORS
I . TESTICULAR TUMORS
. PROSTATE CANCER
I. PENILE CANCER
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RENALTUMORS
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A. Simplifed classifcation o renal tumors:Benign tumors cystic lesion, oncocytoma,
angiomyolipoma (AML)
Malignant :
- Nep ro!lastoma ("ilms# tumor)
- $enal %ell %a (adenocarcinoma, & ypernep roma')
B. $enal masses classifed !y pat ology o $enal umors
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c. $enal masses classifed !y radiograp ic
appearance
Simple cyst
%omple cyst
*atty tumors (AML)
All ot ers:
- +ncocytoma
- $enal cell ca ect.
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A !enign renal neoplasmt is composed o aria!le amounts o at,ascular, and smoot muscle elements
e at density o t e tumour on % as !eenregarded to !e pat ognomonic
t occurs in more t an /0 o indi iduals 1ittu!erous sclerosis, o ten !ilaterally.Angiomyolipomata also occur in 2/0 o 1omen1 o a e a rare, cystic lung disease calledlymp angioleiomyomatosis, or LAM .
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umor 3 2 cm can !e o!ser ed
Nep rectomy in patients 1it acute or
potentially li e-t reatening emorr age
Selecti e em!oli4ation in patients 1it
!ilateral disease
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5 60 o all adult malignanciesMale: *emale: 6 : 78 t and 9 t decade o li e, uncommon in c ild ood$enal cell carcinoma arise rom t e renalepit elium and account or a!out percent orenal cancers
A ;uarter o t e patients present 1it ad anceddisease, (m$%%)A t ird o t e patients 1 o undergo resection olocali4ed disease 1ill a e a recurrence
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T " Primar$ tumour < =rimary tumour cannot !e assessed / No e idence o primary tumour > umour 3 9 cm, limited to t e ?idney- >a umour 3 2 cm.
- >! umour @ 2 cm !ut 3 9 cm 7 umour @ 9 cm 6 umour e tends into ma or eins or adrenal gland or
perinep ric tissues !ut not !eyond erota#s ascia- 6a umour directly in ades adrenal gland or perinep ric
tissues> !ut not !eyond erota#s ascia- 6! umour e tends into renal ein, or t e ena ca a
!elo1 t e diap ragm- 6c umour e tends into ena ca a a!o e diap ragm
2 umour directly in ades !eyond erota#s ascia
RENAL CELL CARCINOMA
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N " R )io*al l$m+, *o- sN< $egional lymp nodes cannot !e assessedN/ No regional lymp node metastasisN> Metastasis in a single regional lymp nodeN7 Metastasis in more t an > regional lymp nodepN/ lymp adenectomy or more lymp nodes arenegati e.
M " 'ista*t m tastasis
M< Cistant metastasis cannot !e assessedM/ No distant metastasisM> Cistant metastasis
RENAL CELL CARCINOMA
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TNM sta) )rou+i*)
Stage > N/ M/Stage 7 N/ M/Stage 6 N/ M/
>, 7, 6 N> M/Stage D 2 N/,N> M/
Any N7 M/ Any Any N M>
RENAL CELL CARCINOMA
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ncidental fndings on ES
S$m+toms : - Fematuria
- *lan? pain
- A!dominalGHan? mass
+t ers: Daricocelle G Lo1er e tremity oedema
Para"* o+lasti# s$m+toms :ncreased LIC G LCF G %aJ
Ene plained e er
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ErinalysisA!dominalGpel ic ultrasound G % or M$ 1itor 1it out contrast depending on renal
unction% est imagingBone scan, i clinically indicatedBrain M$ , i clinically indicated
urot elial carcinoma suspected, considerurine cytology, E$S or retrograde
pyelography %onsider needle !iopsy, i clinically indicated
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Cl ar # ll #o*! *tio*al /0 "
102
=apillary >/ - > 0
% romop o!ic 2 - 0
%ollecting duct 3 >0
Medullary cell 3 >0
+ncocytoma 6 - 90
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Tr atm *t 3
Nep ron-sparing surgery
$adical Nep rectomy
% emot erapi
mmunot erapi
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Lung 7K 2 0
Bone >8 - 79 0Li er 7 - >/ 0
Brain > 9 0
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A!out 5 -90 o all renal tumors402 ar TCC , K0 s;uamous cell ca
%% o t e renal pel is is 6-2 times more re;uentt an %% o t e ureter
: 6-2 : >ncidence increases 1it age, pea?s during 8 t -
9 t decades/0 o ureteral tumors are multicentric -years o erall sur i al rate is signifcantly
related to tumor stage
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Ris5 6a#tors 3% ronic in ection
Long standing stoneAnalgesic a!use
Smo?ing
+ccupation (c emical, petroleum, plastic, coal,asp alt)
I posure to cyclop osp amide (al?ylatingagent)
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'ia)*osti# 3
Fistory : ematuria, painGcolic
Erine cytology
maging : EBG DE, % Scan
Indoscopy : $= , %ystoscopy, E$S (!iopsy prn)
Staging : % est
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Ereterectomy (resection O anastomosis) inselected cases 1 ene er possi!le
Nep ro-ureterectomy
Indoscopic management
nstilation t erapy
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Most common malignancy o t e urinary tract
Male @ *emale
9 - 0 o patients 1it !ladder cancer present
1it disease confned to t e mucosa
e a erage age at diagnosis is 8 years
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Aromatic amines
Smo?ing
rauma to t e urot elium induced !y in ection,
instrumentation, and calculi
enetic
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%% K/ 0S%% >/ 0Adeno %a 7 0Sarcoma
=EN LM=EndiPerentiatedEn?no1n
BLADDER CANCER
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T " Primar$ tumour < =rimary tumour cannot !e assessed / No e idence o primary tumour
a Non-in asi e papillary carcinoma is %arcinoma in situ: QHat tumour#
> umour in ades su!epit elial connecti e tissue 7 umour in ades muscle 7a umour in ades superfcial muscle (inner al )
7! umour in ades deep muscle (outer al ) 6 umour in ades peri esical tissue: 6a Microscopically
6! Macroscopically (e tra esical mass) 2 umour in ades : prostate, uterus, agina, pel ic 1all,a!dominal 1all
2a umour in ades prostate, uterus or agina 2! umour in ades pel ic 1all or a!dominal 1all
BLADDER CANCER
BLADDER CANCER
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N " L$m+, *o- sN< $egional lymp nodes cannot !e assessedN/ No regional lymp node metastasisN> Metastasis in a single lymp node 7 cm or less
in greatest dimensionN7 Metastasis in a single lymp node more t an 7
cm !ut not more t an cm in greatestdimension, or multiple lymp nodes, none moret an cm in greatest dimension
N6 Metastasis in a lymp node more t an cm ingreatest dimension
BLADDER CANCER
BLADDER CANCER
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M " 'ista*t m tastasisM< Cistant metastasis cannot !e assessedM/ No distant metastasisM> Cistant metastasis
BLADDER CANCER
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S$m+toms : Fematuria K/ 0
Cysuria, re;uency, urgency
'ia)*osis :
Erine cytologymaging: ES G EB O DE G % -S%AN
%ystoscopyG E$ O !iopsy :
- umor si4e
- Location G single or multiple
- umor !ase !iopsy
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Bas - o* 3
umor typeGgradeGstageGsi4e
=rimaryGrecurrence
Location
*ocality
%o-mor!idity
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ntra esical % emot erapi
ransuret tral $esection o Baldder umor
$adical %ystectomi
$adiot erapi
% emot erapi
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