1、Neoplasms of Genitourinary System 泌尿系肿瘤,瑞金医院泌尿外科 邵 远,Adenocarcinoma of the Kidney,（ Renal Cell Carcinoma, RCC, 肾细胞癌）,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 occurs most commonly i
2、n 5th6th decade, male-female ratio 2:1,Etiology,Cause: unknownRisk Factors: cigarette smoking, exposure to asbestos （石棉）and tanning（鞣革）products,Etiology,RCC occurs in 2 forms: -inherited（遗传）：chromosome translocation, Von Hippel-Lindau disease -sporadic（散发）,Pathology,RCC originates from the proximal
3、renal tubular epithelium. Types:Clear cell typeGranular cell typeMixed cell typeRCC is most often a mixed adenocarcinoma（腺癌）.,Tumor Staging (Robson System),I: Tumor is confined within the kidney parenchyma. II: Tumor involves the perinephric fat but confined within Gerotas fascia (including the adre
4、nal). IIIA: Tumor involves the main renal vein/inferior vena cava.,Tumor Staging (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.,Clinical Findings,Symptoms & Signs A
5、. Classical triadgross hematuria, 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,Clinical Findings,B. Paraneoplastic Syndromes:eryth
6、rocytosis（红细胞增多症）, hypercalcemia（高钙血症）, hypertension C. Lab Findings: anemia, hematuria(60%), ESR,Clinical Findings,D. X-ray Findings:*Ultrasonography*Intravenous Urography (IVU): 75% accurate (used alone), calcification*CT scanning: more sensitive, mass +renal hilum, perinephric space and vena cava
7、, adrenals, regional LN and adjacent organs *Renal Angiography,IVU of right RCC,CT scan of right RCC,CT scan of left RCC,RCC invading renal vein,Left cystic RCC,Left cystic RCC,Differential Diagnosis,Benign renal tumors:Angiomyolipoma （血管平滑肌脂肪瘤, 错构瘤),Treatment,1. Localized disease:Surgical removal-o
8、nly potentially curative therapyRadical Nephrectomy (en bloc removal of the kidney and Gerotas fascia including ipsilateral adrenal, proximal ureter, regional lymphadenectomy (淋巴结清扫),Treatment,2.Disseminated disease:nephrectomy- reducing tumor burdenradiation- radioresistant tumor, metastases 2/3 ef
9、fectivechemotherapy- 10% effectiveimmunotherapy- IL-2/interferon-alpha, 30% response rate,Prognosis,Stage 5-year survival rate I 88100%II 60%III 1520%IV 020%,Renal Pelvic Cancer,肾盂癌,Incidence: rare, 3% of all urothelial cancersPathology:transitional cell 90%squamous cell 10%,Clinical Findings,A. Sym
10、ptoms & Signsgross hematuria 7090%flank pain 850%B. Lab Findings:hematuria, cytology (40% positive), tumor markers (BTA, NMP22),Clinical Findings,C. ImagingIVU-intraluminal filling defect, unilateral nonvisualization of the collecting system, hydronephrosisUS, CT & MRIUreteropyeloscopy (肾盂输尿管镜),IVU
11、of right pelvic Ca,CT scan of right pelvic Ca,CT of right pelvic Ca,Treatment,Standard therapy-nephroureterectomy (肾输尿管全长切除)removal of the entire distal ureter with a small cuff of bladder,Bladder Carcinoma,膀胱癌,Bladder Ca,The second most common cancer of the genitourinary system, male-female ratio 2
12、.7:1 Initiators/Promoters:cigarette smokingoccupational exposuregenetic events,Staging: TNM System,Histopathology（组织病理学）,Transitional cell carcinoma（移行细胞癌）90% Nontransitional cell carcinoma: adenocarcinoma, squamous cell Ca, undifferentiated Ca,Clinical Findings,A. Symptoms:hematuria 8590%irritative
13、 voiding symptomsB. Signs:Majority of patients have no pertinent physical signs.,Clinical Findings,C. Lab tests:urine testhematuriaurinary cytologydepend on grade and volume of the tumorother markers: BTA, NMP22, telomerase（端粒酶）,Clinical Findings,D. Imaging:UltrasonographyscreenIVUevaluation of uppe
14、r urinary tractCT/MRIassessment of the depth of infiltration and pelvic LN enlargementE. Cystoscopy（膀胱镜）,Ultrasonography of Bladder Ca,IVU of Bladder Tumor,CT scan of bladder Ca,Bladder Ca under cystoscopy,Treatment,1. SurgeryTUR (Trans-Urethral Resection)Partial Cystectomy （膀胱部分切除）Radical Cystectom
15、y（根治性膀胱全切除）2. Radiotherapy,TUR of Bladder Tumor (TURBT),After TUR,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%,Carcinoma of the Prostate CaP,前列腺癌,CaP,The most common cancer in American men I
16、ncreases rapidly with age 95% are adenocarcinoma,Clinical Findings,A. Symptomsearly stage: asymptomatic（无症状）locally advanced/metastatic diseaseobstructive or irritative voiding complaints, bone pain, paresthesias（感觉异常）and weakness of lower extremitiesB. Signs: DREinduration（硬结）,Clinical Findings,C.
17、Tumor markers PSA（前列腺特异抗原） Prostate Specific Antigen20 ng/ml highly suspect of PCa,Clinical Findings,D. Prostate biopsy（活检）golden standardE. ImagingTRUS, MRI, Bone scan,Treatment,1. Localized disease(optimal form in great debating)Watchful waitingRadical prostatectomy（根治性前列腺切除）Radiationexternal beam,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,Thanks for your attention!,
