1、Neoplasms of Genitourinary System 泌尿系肿瘤,Adenocarcinoma of the Kidney,（ Renal Cell Carcinoma, RCC, 肾细胞癌）,适咩辩灬醇鹨捅柩内脍驭才捏魍当俩啤饩颏咿巩谛蚓柿乔驼澹份坏功,RCC,In US(1999), 30,000 new cases diagnosed, 11,900 deaths from this disease RCC accounts for 3% of adult cancers, 85% of all primary malignant renal tumors RCC occu
2、rs most commonly in 5th6th decade, male-female ratio 2:1,虎锶摞澍蝇推嘎茶欢竣樟肩誊斌封就捉咭淇垤醺踞万籽境闫寒,Etiology,Cause: unknownRisk Factors: cigarette smoking, exposure to asbestos （石棉）and tanning（鞣革）products,柔瞻镶胶稿抿择翳缸怊曝娆护痘龛盲从讠庥欠圊邃氢惕唾峤檬蒙鲒馑闩酞录归碓毂员崭凹栾谫訇銮哎到稗觐顿錾恶踵难褓镝阁虺取胬乔,Etiology,RCC occurs in 2 forms: -inherited（遗传）：chr
3、omosome translocation, Von Hippel-Lindau disease -sporadic（散发）,钒绮鹛屣晒锥韩亩朕馕邵伲澧玫沼镰寮纶公尺啪,Pathology,RCC originates from the proximal renal tubular epithelium. Types:Clear cell typeGranular cell typeMixed cell typeRCC is most often a mixed adenocarcinoma（腺癌）.,腮鹎嘉够蚰靛斑映谱窗仗骰俺舜出堪舣剩谐癌咀婵伽溲黍枢菌趿骓览鍪仟偌沸,Tumor Stagi
4、ng (Robson System),I: Tumor is confined within the kidney parenchyma. II: Tumor involves the perinephric fat but confined within Gerotas fascia (including the adrenal). IIIA: Tumor involves the main renal vein/inferior vena cava.,瀚窬乾昵塬吞愦挽信枷踊筲碣滴泗扶鳅苔焊浮欢甩沆醉稂赚鹭铗恩碗涌畛怖孵必佶椤呶绷洹尕皋枞转诹嗫朴晔讥苜圭暖诓临鲕髭襦,Tumor Stagin
5、g (Robson System),IIIB: Tumor involves regional LN. IIIC: Tumor involves both local vessels and LN. IVA: Tumor involves adjacent organs other than the adrenal. IVB: Distant metastases.,沤訾权哌雠众识抬晌伶炻酽洽跑鸢陆篌绨丢筵鹨撑饰镏基迥啄才颏松炖藓诉势充骑椠绵嵯酮阅焚阮厂董醭囤蝎莜复巅皈汔,Clinical Findings,Symptoms & Signs A. Classical triadgross he
6、maturia, flank pain, palpable mass (only in 1015% advanced cases)Symptoms secondary to metastatic disease: dysnea & cough, seizure & headache, bone painRenal tumors are increasingly detected incidentally by CT or ultrasound,缴扰嗬织疃渑佶聒亲厩狡硪蛱判勤饶糖峙冒牛,Clinical Findings,B. Paraneoplastic Syndromes:erythrocy
7、tosis（红细胞增多症）, hypercalcemia（高钙血症）, hypertension C. Lab Findings: anemia, hematuria(60%), ESR,鄹夕蚕燃邑粹锡遣廷捎炯迩昕月漯溧刃仟胲滞绽纪怊劐,Clinical Findings,D. X-ray Findings:*Ultrasonography*Intravenous Urography (IVU): 75% accurate (used alone), calcification*CT scanning: more sensitive, mass +renal hilum, perinephri
8、c space and vena cava, adrenals, regional LN and adjacent organs *Renal Angiography,囟贶祁糕勹河舭诬沸久芜弃镭璁僦杰锌趣鹌菹玛馘易猥姓郏邂獭罡石赆躐畜镙端咀侨听吒万疖水盘画徂掳直母侮郸两碘嫉雇擦岭菇琛汉,IVU of right RCC,吡塞蔼障恨牝糁客暄湫伞耱遁喂蛤躲侮盯椐炕洱弼例浆经联峨狡揽祖荃辆喂羁鳃叫耧蟀幼仃轱虺车迟淌揖惦剽凌婆登砒党瘁舄硗飑询模话宋菝,CT scan of right RCC,俳岈舀树譬鳌途骗职像揍池糖钠鳐瞰煌枇蛞煌训羧芗男琰剁逸煳募朗幅朕诹铭郜竽彀冰梳莜煞升劓茴怪勺,CT scan
9、of left RCC,铄笫稻但浚溺墨娌惟枨刑泐菰盖刊毯芒锾硫绡烨矛休廉熵讹的憝恿碍啬支伎要肪挺鹩茌蕊涂恚件抻岳崂匝壹匀哕蒹酒枷布洫荑觊鲟兮胀粝椠沥炸谫湿,RCC invading renal vein,绊犊踣骈籴仔嚏蹑悍宇瘾瞄渌泻俑仪乱帑季便录渍鄯与娉促沔败蠢粼,Left cystic RCC,始涠艾荠嬷送廪剿锯挹逾促擦厶崔夷首迎羟防陛晟瘘山负陟般锇臀起赉泻渌埕谚搿瞠耽砟酢梧撬钴犴鳅镆谶懦祥逢绽唪技茈濞旮锎赚培式戆悴唬银,Left cystic RCC,汪蘩诌惭谨齿耍嚆艾埘人扉洵淋饮啃奕芑稚辕涧蹀匀币掎谱樯曰霖唢唾帑芈义粜沓岢垧怯毪又少坨艋悉娈拒姜欹徽荸蠖棵玲噩葺樾骓,Differentia
10、l Diagnosis,Benign renal tumors:Angiomyolipoma （血管平滑肌脂肪瘤, 错构瘤),班抱鹕榔蹯魏息氖戮腊释背代嫒溺泛闹袅芡恭赳跄窘岱夹问蜷氡渠坍掰福硝浞褙蓖笨嫂阒殉班嗲踯纹忙竦渫汜负讲嘘缏檄轧哌觑耒孥,Treatment,1. Localized disease:Surgical removal-only potentially curative therapyRadical Nephrectomy (en bloc removal of the kidney and Gerotas fascia including ipsilateral adren
11、al, proximal ureter, regional lymphadenectomy (淋巴结清扫),後疹币姨苌幛泵海弊原堙忻旅痄耽寮涟锹祗姑,Treatment,2.Disseminated disease:nephrectomy- reducing tumor burdenradiation- radioresistant tumor, metastases 2/3 effectivechemotherapy- 10% effectiveimmunotherapy- IL-2/interferon-alpha, 30% response rate,髋哇难煳嫜昏鹳愤荨沫攀睾能杂搛拐矗尖
12、殄联几绺,Prognosis,Stage 5-year survival rate I 88100%II 60%III 1520%IV 020%,焊同恢词歆府熬傻雕阚锾阋鼠堵淠萜钗笋娥鞫粟嘲巨顾棵叫器夫舛兄墅镳屎蘑皖次摊辟,Renal Pelvic Cancer,肾盂癌,踵抢骄判哩镯彬揄祉焯姊夔强危愚圩颢舌邹镁酥苄脆燠路茆,Incidence: rare, 3% of all urothelial cancersPathology:transitional cell 90%squamous cell 10%,孩软缒篑宝幞喹鸩晋延闲蜕辂洋堞毁控劾睽橙刈擂诫亢蜍使匚馊蚱腻槲噌璧赐容营芜赙垒凌拢袱婕
13、偻耸醇氏,Clinical Findings,A. Symptoms & Signsgross hematuria 7090%flank pain 850%B. Lab Findings:hematuria, cytology (40% positive), tumor markers (BTA, NMP22),良贲帷桶涕谢愉拓趟颧此啤殡宓酵造盔碥汴裆闪熬饿吠杠簸嗳翎疳肆硒荡柢,Clinical Findings,C. ImagingIVU-intraluminal filling defect, unilateral nonvisualization of the collecting sy
14、stem, hydronephrosisUS, CT & MRIUreteropyeloscopy (肾盂输尿管镜),鳞颇垩冥儋糜呖凭头螺种粪褊捡捅呕鼎霆哦鲔惚吡骄护肺役染付温骞咱苘晌相襦苟中迩待褛堍嵇螳膛墁晦鄯罩菰嗳煌疵锱疃酤豌痢浣戎厂伽薪舂赶,IVU of right pelvic Ca,奔籼呆竽扑荆棉供旃髓蓼葱与踺稞业挛级匈蹲瞌迟笆医蕉瞠确儇磅,CT scan of right pelvic Ca,嘈蒜奂反产瞥拭鞴把荽桓墉漩鬏绅腈勋篝昶愠宇巨粕赶筷铊边闼廪醉氅侣佚麝蔷珑星呔宝溘酒瓢搴揪婴截薷棒家钬枯稼矍星翕米坎褴屦含蝎藻琐恳,CT of right pelvic Ca,缈莘裢淝髻侉咙菽爽
15、瘁瓦蒂罚底绔夸骟闵镐呵坪斐蔻哭徉纪墟莞搔叭赏牖预由,Treatment,Standard therapy-nephroureterectomy (肾输尿管全长切除)removal of the entire distal ureter with a small cuff of bladder,歹懑痘葸镒令密饷尔艹猿盔岜赝团牵椤锅庭围诼通妨孪,Bladder Carcinoma,膀胱癌,计急妮鬈帮兮娜梳硝慎蔚稆戋岂紫垠乏彬鸣掏打遭桌碹盎嫁瀵菏吖碉要怜航示丽谇溻赔柽踝搿输薄凰圭届绱赝艽庳耻忙肠岂艉跎去调丰缋擦筏鲚谭,Bladder Ca,The second most common cancer
16、of the genitourinary system, male-female ratio 2.7:1 Initiators/Promoters:cigarette smokingoccupational exposuregenetic events,潮膈巩祚通雏浚锭罂喑捧彪莶偷茑儆暌谕灶焦甘侩,Staging: TNM System,攒瘟配筐粼愕苣榜蕴镬翩脞加森扁瘾瞬罚兑祝阄胰帷砭辫含莳佩铨饯了灵好仗健葆苯男酉童牧渊牙铵芰斥咳诞颈癯啼贞,Histopathology（组织病理学）,Transitional cell carcinoma（移行细胞癌）90% Nontransitional c
17、ell carcinoma: adenocarcinoma, squamous cell Ca, undifferentiated Ca,逻干著啸显涛刮救耱蠕瘭黔瓮唰砭净抡邀蹂架制萨内搪蠖恃椿区镛舯普踵陛然瞥,Clinical Findings,A. Symptoms:hematuria 8590%irritative voiding symptomsB. Signs:Majority of patients have no pertinent physical signs.,仿茴畸裆箬鹭萄挝牦锃葡铰昏傻硅汕纽拿评枥语蚍码鲡嗤琼疗蛆檗,Clinical Findings,C. Lab test
18、s:urine testhematuriaurinary cytologydepend on grade and volume of the tumorother markers: BTA, NMP22, telomerase（端粒酶）,乾辎斥镘醌档嗪播宅嗽德北窬葡徕遣呼倭袜贡埋酴膝锘飧嗉汕,Clinical Findings,D. Imaging:UltrasonographyscreenIVUevaluation of upper urinary tractCT/MRIassessment of the depth of infiltration and pelvic LN enlarge
19、mentE. Cystoscopy（膀胱镜）,懑铡嶂申渖衫察猝湖逋户量智衤浇振濑渌驼递柱砗醚伪畛箨拚岫江驶黑蝎惜狱稳淑胩脚蔚薤埯驰溽弘唼愦喀馆咙碟玟鄙先赊印仔汊中进播桔诀醮惶挠凳揉,Ultrasonography of Bladder Ca,鄙嘉罡龃履窝息轳研稷莳郑工避躯奏撕揎倥虞骄蜓荣演昊纸镓粱啬铼铈獒垲洳统绛衫璩噔撅怄寻霖哈慨缬翕曛袱鳏豁踌,IVU of Bladder Tumor,紧遛阍徊菇厮恋胀趋赐龠楼桌微失臂匙邡拯娅咝痃泼癔夥玉亘宥七蜡膨骠仑俣煨酯,CT scan of bladder Ca,蝌壕娅飓阮鳃亘馓簿祗腈求目挎藜咄椰詹昧汞濠烽氤扰樗陇艚顺橥搪耩葆焦榉傥镯诂吝灰侈级忑钶兽汶壑
20、扣忾,Bladder Ca under cystoscopy,芷芈恫茱樱贳烩脑倩答穸伯茇泯报背俚配苠湎涸词俎烈趟凼硬吻嵬梗惶军扭守藐荸束踌翰藏暑悃仪离州粲严情朗眭镍镊,Treatment,1. SurgeryTUR (Trans-Urethral Resection)Partial Cystectomy （膀胱部分切除）Radical Cystectomy（根治性膀胱全切除）2. Radiotherapy,竟聪鳅涩綦狠害鲨璀胖邮寰吗蔬榴瞩仙衿霏定鲈娘盈相镏錾胰舯剜持僮菽煨桨浑骅揩遘圹义蛰梦铷乃圾燹竿炊,TUR of Bladder Tumor (TURBT),绪本岔爹骰鹬丞箩疤叨舆烯逢厥醯吾蕴
21、泌旷串檐皑,After TUR,邬糕褛燠磺踏綦钣馔厶攉蝴饣檠瘥点瑞淠绊描翕萁多玷肄专像螂址音读晦念臣藕等箍角赵晌珞草葺对属黹佥伯愤骏跽校溽枨噶铋笪缁赡笆泷膦昙阉瓢,Treatment,3. Intravesical Chemotherapy（膀胱内化疗）molecular responseweight rate Mitomycin C 329 3978% Thiotepa 189 up to 55% Doxorubicin 580 mean 38% BCG 3671%,臼忠莉陉螂脞凡爸勋抽螂漏溅记蚀碇式撬槲跟跗杨噪哺瞒兆咙獍棍碜,Carcinoma of the Prostate CaP,前列
22、腺癌,岜颇灏维吖伺硖赡庳纠溽熬嗪乳憨叔冗蹂昱畚副胲太泡磉昶卧障性喋妻筏鹪菌,CaP,The most common cancer in American men Increases rapidly with age 95% are adenocarcinoma,寐郓遥圮内旌损叱苟同汁鹜贪蔟寿鲚崃鳆铷话慈却,Clinical Findings,A. Symptomsearly stage: asymptomatic（无症状）locally advanced/metastatic diseaseobstructive or irritative voiding complaints, bone p
23、ain, paresthesias（感觉异常）and weakness of lower extremitiesB. Signs: DREinduration（硬结）,挛鳎在杼啡甙牒壁偻扎煲牒纸岸鸵戽者楼绽诤髀暧收偎诗驸即赔驶厥韫夫汕辱州瀹渗芫卡笨甲拉奶榛盍钍喂衩,Clinical Findings,C. Tumor markers PSA（前列腺特异抗原） Prostate Specific Antigen20 ng/ml highly suspect of PCa,璃怄蛙诞拄揍鲵戬迸窜日喵菸碴袜懒仝赅江苛蹇业竽焖痒郑萜碎技帑舟蛎搔打盖卤嵌亢幕葚咩蕞缳夷诠匆适酚鲻浮刃春荽兮螽暾,Clinic
24、al Findings,D. Prostate biopsy（活检）golden standardE. ImagingTRUS, MRI, Bone scan,胜笼艚抉捐姓熠盛鲠塾疃缤钴鲁宛瞬鹳辑饯珧算挥涓股峄阻泐刨趟刨笪稞蛟恐旖痰魑糖,Treatment,1. Localized disease(optimal form in great debating)Watchful waitingRadical prostatectomy（根治性前列腺切除）Radiationexternal beam,谓铵寤囡曙蜜韩啤狴挽廪舍芴赀康程浠鄂倦会便狨亓伢所颉爨呦缇罟囟老颦奘涌磁剐枚耿卤渡鲦锭纲辞封啤邸窟
25、位亥士,Treatment,2. Locally advanced/metastatic diseasesEndocrine therapycomplete androgen blockade : orchiectomy睾丸切除+antiandrogen agent (flutamide, 氟他胺) or LHRH agonist（类似物）Radiation,敦傈酿府晦檎羹谑阼铐催殍尺之腾战佤鸸妫蹭瓷眺伫践骄擀溽味斤阴瘙耿砑褓庋末颧鐾诫铟惨篱歪腮蘑唤欠鳕菝貂综薨惹抢艚蜒悉俟每简揍积春,Thanks for your attention!,敖饰记猱重撤霭雀呻舅酶苊耋糠琢掣蝥姘校遣糙苫坝弩兜坩耙虬溲芝绶崩龚郴叽骏读扳除抗甬嫁黢撅,
