Transcript Master dia`s HVP

Urogenital Neoplasms
Liping Xie
Department of Urology, First Affiliated Hospital, School of Medicine,
Zhejiang University
Renal Cell Carcinoma (RCC)
Renal Cell Carcinoma (RCC)
• RCC accounts for 2% to 3% of all adult malignant ,
85% of all primary malignant renal tumors, is the most
lethal of the urologic cancers
• Renal cell carcinoma (RCC) affects 38,000 individuals in
the U.S. yearly, and 11,900 patients die of this disease
• RCC occurs most commonly in 5th~6th decade, malefemale ratio 1.6:1
Renal Cell Carcinoma (RCC)
Etiology
• Majority of RCC occurs sporadically
• Tobacco smoking contributes to 24-30% of RCC cases
- Tobacco results in a 2-fold increased risk
• Occupational exposure to cadmium, asbestos, petroleum
• Obesity
• Chronic phenacetin or aspirin use
• Acquired polycystic kidney disease due to dialysis results
in 30% increase risk
Renal Cell Carcinoma (RCC)
Etiology
• 2-4% of RCC associated with inherited disorder
* Von Hippel-Lindau disease
- familial cancer syndrome of retinal angiomas, CNS
hemangioblastomas, pheochromocytomas and clear cell RCC.
* Hereditary papillary renal cancer
- Multiple, bilateral papillary renal tumors , C-met oncogene
on ch 7
* Birt-Hogg-Duke syndrome
- Fibrofolliculomas, lung cysts, and RCC, Mutation in BHD
gene ch 17p
Renal Cell Carcinoma (RCC)
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.
Renal Cell Carcinoma (RCC)
Clinical Findings
Symptoms & Signs
Renal tumors are increasingly detected incidentally
by CT or ultrasound
A. Classical triad——gross hematuria, flank pain,
palpable mass (only in 10~15% advanced cases)
• Symptoms secondary to metastatic disease: dysnea &
cough, seizure & headache, bone pain
Renal Cell Carcinoma (RCC)
Clinical Findings
B. Paraneoplastic Syndromes
• Erythrocytosis, hypercalcemia, hypertension
C. Lab Findings
• anemia, hematuria (60%), ESR↑
Renal Cell Carcinoma (RCC)
Clinical Findings
B. Paraneoplastic Syndromes
• Erythrocytosis, hypercalcemia, hypertension
C. Lab Findings
• anemia, hematuria (60%), ESR↑
Renal Cell Carcinoma (RCC)
Clinical Findings
D. Imaging
• Ultrasonography
• Intravenous Urography (IVU):
• CT scanning: more sensitive, mass+renal
hilum, perinephric space and vena cava,
adrenals, regional LN and adjacent organs
• Renal Angiography
• MRI: to evaluate collecting system and IVC
involvement
Renal Cell Carcinoma (RCC)
Diagnosis
• No screening for the general population
• No bio-marker available
• Radiographic evaluation
Renal Cell Carcinoma (RCC)
IVU of right RCC
CT Scan of Left RCC
Renal Cell Carcinoma (RCC)
Righ Cystic RCC
RCC invading renal vein
Renal Cell Carcinoma (RCC)
CT scan with 3D reconstruction
Neovascularity in Renal
Angiography
associated with RCC
Renal Cell Carcinoma (RCC)
A, Magnetic resonance scan of
kidneys without administration of
gadolinium suggests anterior right
renal mass.
B, After intravenous administration
of gadolinium-labeled
diethylenetriaminepentaacetic acid,
MRI shows enhancement of this mass
indicative of malignancy.
Renal Cell Carcinoma (RCC)
Tissue Diagnosis
• Tissue diagnosis obtained from nephrectomy or biopsy
Papillary (chromophilic) renal cell
carcinoma extending into the collecting
system with histological findings
Renal Cell Carcinoma (RCC)
Tumor Staging (Robson System)
Renal Cell Carcinoma (RCC)
Tumor Staging (International TNM
Staging System)
Renal Cell Carcinoma (RCC)
Tumor Staging
Renal Cell Carcinoma (RCC)
Differential Diagnosis
• Benign renal tumors
-Angiomyolipoma
• Renal Pelvis Cancer
Renal Cell Carcinoma (RCC)
Treatment
A. Localized disease:
• Surgical removal---only potentially curative therapy
• Radical Nephrectomy (en bloc removal of the kidney
and Gerota’s fascia including ipsilateral adrenal,
proximal ureter, regional lymphadenectomy
Renal Cell Carcinoma (RCC)
Laparoscopic Radical Nephrectomy
Hand-Assisted Laparoscopic
Radical Nephrectomy
Renal Cell Carcinoma (RCC)
Treatment
A. Localized disease:
• Partial Nephrectomy(nephron-sparing surgery, NSS )
--polar tumor
--tumor size<4cm
--bilateral RCC
--solitary kidney
Laparoscopic NSS
Renal Cell Carcinoma (RCC)
Treatment
A. Localized disease:
• Percutaneous/Lapar
oscopic
Radiofrequency
Ablation or
Cryoablation
Laparoscopic Cryoablation
Renal Cell Carcinoma (RCC)
Treatment
B. Disseminated disease:
• nephrectomy--- reducing tumor burden
• radiation--- radioresistant tumor, metastases 2/3
effective
• chemotherapy--- <10% effective
• immunotherapy--- IL-2/interferon-alpha, 30% response
rate
• molecular therapy---eg. sorafenib
Prognosis
• Stage
• I
• II
• III
• IV
5-year survival rate
88~100%
60%
15~20%
0~20%
Bladder Cancer
Bladder Cancer
The second most common cancer of the
genitourinary system (most common in China)
The male-female is 2.7:1
The peak incidence is in persons from 50-70 years
Bladder Cancer
Etiology




Industrial toxins
Cigarette smoking
Genetic events
Other risk factors
cyclophosphamide, alkylating agents,
radiotherapy of pelvis.
Bladder Cancer
Pathology
 Histopathlogy
1.transitional cell carcinoma 90%
2.squamous cell carcinoma 7-8%
3.adenocarcinoma
1-2%
4.other types
 Grading
Grade 1
Grade 2
Grage 3
mild anaplasia
moderate anaplasia
marked anaplasia
Bladder Cancer
Clinical Findings
A. Symptoms:
• Painless Hematuria 85~90%
• Irritative voiding symptoms
B. Signs:
• The majority of patients have no pertinent
physical signs.
Bladder Cancer
Clinical Findings
C. Lab tests:
• Urine test——hematuria
• Urinary cytology——depend on grade and
volume of the tumor
• Other markers: BTA, NMP22, telomerase
Bladder Cancer
Clinical Findings
D. Imaging:
• Ultrasonography—screen
• IVU—evaluation of upper urinary tract
• CT/MRI—assessment of the depth of
infiltration and pelvic LN enlargement
E. Cystoscopy
Bladder Cancer
Diagnosis

Ultrasonography can be used as screening method to
detect bladder tumors and upper urinary tract
obstruction.

both CT and MRI are used to characterize the extent of
bladder wall invasion and detect enlarged pelvic lymph
node.
Bladder Cancer
Diagnosis
 Cystoscopy
the diagnosis of bladder cancer depends on cystoscopy.
cystoscopy can provide good information on the extent of the
tumour.
suspicous areas can be biopsied.
Bladder Cancer
Ultrasonography of Bladder
Ca (Arrow Head)
IVU of Bladder Tumor
Bladder Cancer
CT scan of bladder Ca
Bladder Cancer
Cystoscopy of bladder Ca
Bladder Cancer
TNM Tumor Staging
Bladder Cancer
TNM Tumor Staging
Bladder Cancer
Treatment
 Superficial bladder cancer (Ta,T1,Tis)



transurethral resection
intravesical chemotherapy or immnotherapy(BCG)
cystoscopic surveillance
Bladder Cancer
Treatment
 Invasive bladder cancer (T2-T4)
partial cyctectomy
solitary, inflitrating tumors localized along the posterior lateral
wall or dome of the bladder.
radical cystectomy
1.muscle-invasive bladder cancer T2-T4a, N0-NX, M0. 2.high-risk superficial
tumours (T1G3, BCG-resistant Tis) 3.extensive papillary disease
Urinary diversion after radical cystectomy
Bladder Cancer
partial cyctectomy
Bladder Cancer
Radical Cystectomy
Bladder Cancer
Treatment
 Radiotherapy
Modern 3D-radiotherapy is a reasonable treatment option in
patients who wish to preserve their bladder
 Chemothery
chemothery for metastatic disease.
adjuvant chemotherapy
Neoadjuvant chemotherapy
Prostate Cancer
Prostate Cancer
• The most common cancer
diagnosed and is the second
leading cause of cancer
death in American men
• the incidence of prostate
cancer is continuously
increasing each year in
china
• The incidence increases
with advancing age
Prostate Cancer
Risk factor
• Age
• Genetic influences
Race－African Americans are at a higher risk than
whites
• Positive family history
• High dietary fat intake
• Hormonal factors

androgen dependence
Others
Prostate Cancer
Pathology
• Over 95% of the cancers of the prostate are
adenocarcinomas.
• Prostatic intraepithelial neoplasia (PIN)
high grade (HGPIN)
low grade (LGPIN)
Prostate Cancer
Mostly arise from the
peripheral zone of the
gland
Prostate Cancer
Grading
• the Gleason system is widely used for its best clinical correlation
Prostate Cancer
Staging
• Stage I small foci of carcinoma in resection for
benign disease
• Stage II disease confined to prostate
• Stage III extracapsular extension
• Stage IV regional lymph node metastases or distant
metastases
Prostate Cancer
The TNM staging
system
Prostate Cancer
Clinical Findings
A. Symptoms
• Early stage: asymptomatic
• Locally advanced/metastatic disease—
obstructive or irritative voiding complaints,
bone pain, paresthesias and weakness of lower
extremities
Prostate Cancer
Clinical Findings
B. Signs:
• Digital rectal examination—induration
Prostate Cancer
Clinical Findings
C. Tumor markers
Prostate Specific Antigen (PSA)
•
< 4 ng/ml
•
4 ~ 10 ng/ml Grey Zone
•
> 10 ng/ml
normal
highly suspect of PCa
Prostate Cancer
Clinical Findings
D. Imaging
• Ultrasonography－hypoechoic lesion
Transrectal ultrasonography (TRUS)
• CT, MRI
• Bone scan
Prostate Cancer
Clinical Findings
E. Prostate biopsy
• The golden standard
Prostate Cancer
MRI of prostate cancer
Prostate Cancer
Bone scan
Prostate Cancer
Treatment
A. Localized disease
• Watchful waiting, older patients with samll,
well-differentiated cancer
• Radical prostatectomy, patients with a life
expectency > 10 years
• Radiation
Prostate Cancer
Radical Prostatectomy
Prostate Cancer
Prostate Cancer
Treatment
B. Locally advanced/metastatic diseases
• Endocrine therapy—androgen blockade :
orchiectomy
antiandrogen agent
LHRH agonist
• Radiation
• Chemotherapy
Further Reading
Renal Pelvis Cancer / Tumor of Ureter
Penile Cancer
Testicular Cancer
Further Reading
Thank you for your attention !