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Treatment

Treatment . Localized disease: Radical nephrectomy . Metstatic disease: Radiation therapy. Immunotherapy PROGNOSIS: stage1 80-100% 5yrs survival stageII 60% 5yrs survival. Urethelial tumor of the renal pelvis. 4% of urethelial tumors. Male-Female ratio 4-1.

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Treatment

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  1. Treatment • Localized disease: Radical nephrectomy. • Metstatic disease: Radiation therapy. Immunotherapy • PROGNOSIS: stage1 80-100% 5yrs survival stageII 60% 5yrs survival.

  2. Urethelial tumor of the renal pelvis • 4% of urethelial tumors. Male-Female ratio 4-1. High incidence of multicentric. • Etiology: Risk factor: smoking industrial dye,solvent, analgesic such as phenacetin,aspirin,caffeine, acetaminophen.. Pathology: Majority are Transitional cell carcinoma. Rarely squamous cell carcinoma,or adenocarcinoma.

  3. Pathology of TCC. Metastasis:Regional LNs,Lung,bone. Staging: TNM:Ta.Tis: confined to mucosa. T1 Invasion of lamina propria. T2 Invasion of muscularis. T3a Invasion of deep muscles. T3b Extension into fat or renal parechyma. T4 Spread to adjacent organs. N+ LNs Metastasis. M+ Distant metastasis.

  4. Clinical Findings: • Symptoms&Signs: Gross Hematuria. Flank pain. Flank mass(Hydronephrosis). Weight loss anorexia. • Laboratory: Hematuria. Urine cytology(voided urine or ureteric catheter).

  5. X-ray • I.V.U.

  6. Retrograde Pyelogram:

  7. Ureteropyeloscopy: Ultrasonography: C.T.

  8. Treatment: Localized Tumor: -Nephroureterectomy. -Conservative :open or endoscopic excision + instillation of immuno-0r chemotherapeutic Single kidney. Bilateral tumors. Metastatic Tumor: Chemotherapy.

  9. Adrenal gland: Benign Tumors: -Adenoma. Malignant: - Neuroblastoma.

  10. Neuroblastoma of Adrenal Gland -Origin:Neural crest. -Age:1st 2 ½ yrs. -Poor prognosis. -Hereditary. -Rarely bilateral. Clinical Findings: Symptoms: Abdominal mass (parent). Symptoms related to metastases (failure to thrive, Fever,malaise,bone pain,constipation,diarrhea).

  11. Signs: -Palpable,visible abdominal mass. -In metastatic patient: enlarged nodular liver,mass in bone,ocular protrusion. - Hypertension. Laboratory Findings: -Anemia. -Increase level of serum epinephrine , nor epinephrine, and urinary VMA. X-ray Findings: U.S, I.V.P, CT, Angiography.

  12. Treatment: Localized Tumor: -Tumor Excision followed by radiotherapy to the tumor bed -Very large tumor :Radiotherapy followed by excision. Metastatic Tumor: Chemotherapy.

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