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U rogenital Neoplasms

U rogenital Neoplasms. Liping Xie. Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University. Renal Cell Carcinoma (RCC). Renal Cell Carcinoma (RCC).

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U rogenital Neoplasms

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  1. Urogenital Neoplasms Liping Xie Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University

  2. Renal Cell Carcinoma (RCC)

  3. 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, male-female ratio 1.6:1

  4. 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

  5. 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

  6. 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.

  7. 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

  8. Renal Cell Carcinoma (RCC) Clinical Findings B. Paraneoplastic Syndromes • Erythrocytosis, hypercalcemia, hypertension C. Lab Findings • anemia, hematuria (60%), ESR↑

  9. Renal Cell Carcinoma (RCC) Clinical Findings B. Paraneoplastic Syndromes • Erythrocytosis, hypercalcemia, hypertension C. Lab Findings • anemia, hematuria (60%), ESR↑

  10. 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

  11. Renal Cell Carcinoma (RCC) Diagnosis • No screening for the general population • No bio-marker available • Radiographic evaluation

  12. Renal Cell Carcinoma (RCC) IVU of right RCC CT Scan of Left RCC

  13. Renal Cell Carcinoma (RCC) Righ Cystic RCC RCC invading renal vein

  14. Renal Cell Carcinoma (RCC) CT scan with 3D reconstruction Neovascularity in Renal Angiographyassociated with RCC

  15. 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.

  16. Renal Cell Carcinoma (RCC) Tissue Diagnosis • Tissue diagnosis obtained from nephrectomy or biopsy Papillary (chromophilic) renal cell carcinoma extending into the collecting systemwith histological findings

  17. Renal Cell Carcinoma (RCC) Tumor Staging (Robson System)

  18. Renal Cell Carcinoma (RCC) Tumor Staging (International TNM Staging System)

  19. Renal Cell Carcinoma (RCC) Tumor Staging

  20. Renal Cell Carcinoma (RCC) Differential Diagnosis • Benign renal tumors -Angiomyolipoma • Renal Pelvis Cancer

  21. 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

  22. Renal Cell Carcinoma (RCC) Hand-Assisted Laparoscopic Radical Nephrectomy Laparoscopic Radical Nephrectomy

  23. 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

  24. Renal Cell Carcinoma (RCC) Treatment A. Localized disease: • Percutaneous/Laparoscopic Radiofrequency Ablation or Cryoablation Laparoscopic Cryoablation

  25. 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

  26. Prognosis • Stage 5-year survival rate • I 88~100% • II 60% • III 15~20% • IV 0~20%

  27. Bladder Cancer

  28. 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

  29. Bladder Cancer Etiology • Industrial toxins • Cigarette smoking • Genetic events • Other risk factors cyclophosphamide, alkylating agents, radiotherapy of pelvis.

  30. 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 mild anaplasia Grade 2 moderate anaplasia Grage 3 marked anaplasia

  31. Bladder Cancer Clinical Findings A. Symptoms: • Painless Hematuria 85~90% • Irritative voiding symptoms B. Signs: • The majority of patients have no pertinent physical signs.

  32. 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

  33. 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

  34. Bladder Cancer Diagnosis • Ultrasonography can be used as screening method to detect bladder tumors and upper urinary tract obstruction. • both CTand MRIare used to characterize the extent of bladder wall invasion and detect enlarged pelvic lymph node.

  35. 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.

  36. Bladder Cancer Ultrasonography of Bladder Ca (Arrow Head) IVU of Bladder Tumor

  37. Bladder Cancer CT scan of bladder Ca

  38. Bladder Cancer Cystoscopy of bladder Ca

  39. Bladder Cancer TNM Tumor Staging

  40. Bladder Cancer TNM Tumor Staging

  41. Bladder Cancer Treatment • Superficial bladder cancer (Ta,T1,Tis) • transurethral resection • intravesical chemotherapy or immnotherapy(BCG) • cystoscopic surveillance

  42. 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

  43. Bladder Cancer partial cyctectomy

  44. Bladder Cancer Radical Cystectomy

  45. 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

  46. Prostate Cancer

  47. 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

  48. 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

  49. Prostate Cancer Pathology • Over 95% of the cancers of the prostate are adenocarcinomas. • Prostatic intraepithelial neoplasia (PIN) high grade (HGPIN) low grade (LGPIN)

  50. Prostate Cancer Mostly arise from the peripheral zone of the gland

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