Suspected Malignancy B 陳建佑

Symptoms Red Urinary Hesitance Urination

Renal Cell Carcinoma Site ： kidney Risk factors ： 1. Cigarette smoking (X2 risk, 1/3 cause of RCC) 2. Obesity (particularly in women 3. Hypertension 4. Phenacetin-containing analgesia taken in large amounts 5. Acquired cystic disease of the kidney in patients undergoing long-term renal dialysis 6. Tuberous sclerosis 7. Renal transplantation 8. VHL disease (Deletions of 3p )

Renal Cell Carcinoma Symptoms ： Most common presentations Hematuria (40%) Flank pain (40%) Palpable mass in the flank or abdomen (25%) Other signs and symptoms: Weight loss (33%) Fever (20%) Hypertension (20%) Hypercalcemia (5%) Night sweats Malaise

Renal Cell Carcinoma Diagnostic approaches ： 1. Intravenous pyelogram (IVP) 2. Ultrasound exam 3. CT scan 4. MRI

Tumor Markers CD10 and RCC Often expressed by clear cell renal cell carcinomas, and they may be useful markers to suggest a renal origin of carcinomas. Ferritin Higher levels in the renal vein, its positive correlation with tumor size and volume suggest that ferritin is expressed by RCC. Initial peripheral serum values of ferritin can be indicative of disease status and also be a prognosticator of survival.

Radiography of RCC line is caused by the natural contrast provided by retroperitoneal fat lying against the psoas muscle Black spot indicates that the mass is retroperitoneal because it has dispalecd the retroperitoneal fat and now there is a water density soft tissue mass adjacent to the water density psoas and thus no visible boundary between them.

CT of RCC

Ultrasound of RCC Dark grey (hypo-echoic) cortex surrounding light grey (hyper-echoic) medulla. A solid mass (arrow) of slightly greater echogenicity than renal cortex is seen arising from the kidney.

MRI of RCC

Renal Pelvis & Ureter Cancer Risk Factors ： 1. Analgesic nephropathy 2. Exposure to certain dyes and chemicals used to manufacture leather goods, textiles, plastics, and rubber 3. Smoking Symptoms ： 1. Back pain, located where ribs and spine meet 2. Bloody urine / Dark, rust-colored, or brown urine 3. Burning, pain, or discomfort with urination 4. Fatigue, Unintentional weight loss 5. Nocturnal urinary 6. Urinary frequency or urgency but hesitancy

Renal Pelvis & Ureter Cancer Diagnostic approaches ： 1. Rare mass or enlarged kidney in PE 2. Urine cytology 3. The tumor or signs of urinary obstruction, may appear on: a. Abdominal CT scan b. Intravenous pyelogram (IVP) c. Kidney ultrasound d. MRI of abdomen e. Renal scan

Radiography Left anterograde pyelography showing a filling defect approximately 3 cm in diameter suggesting an urothelial neogrowth.

CT Tumor occupying the right ureter lumen with thickening of ureteral wall.

Bladder Cancer Risk Factors ： 1. Exposure to chemicals 2. Cigarette smoke (X6~10) 3. Family history Symptoms ： 1. painless and intermittent Hematuria (1.5%) 2. Flank, perineum pain; (flank region  complete or partial blockage of the ureter on that side, with the pain being due to back pressure of urine.) 3. Voiding symptoms 4. Bodywide symptom

Bladder Cancer Diagnostic approaches ： 1. Urinalysis, Urine cytology 2. IVP (intravenous pyelogram) 3. CT scan 4. Cystoscopy & biopsy

Tumor Markers BTA (Bladder Tumor Antigen) 1. Won’t present when normal 2. False Positive when a. Recent invasive procedure b. Infection genitourinary tract c. Cancer of kidney, ureters NMP Normal <10 ng/ml 2. False Positive when a. Chemotherapy b. Benign GU disease, renal/bladder stone

IVP

CT

Cystoscopy

Prostate Cancer Risk Factors ： 1. Genetic 2. Diet; high trans-fat, low Vit E & selenium 3. Medication Exposure; anti-inflammatory medicine :aspirin,ibuprofen 4. Infection; chlamydia, gonorrhea, or syphilis Symptoms ： 1. Early state usually causes no symptoms. elevated PSA noticed during a routine checkup 2. Frequent urination 3. Increased urination at night 4. Difficulty starting of urine 5. Blood in the urine 6. Painful urination 7. Difficulty achieving erection or painful ejaculation

Prostate Cancer Diagnostic approaches ： 1. molecular test cell-associated PCA3 mRNA in urine 2. Prostasomes 3. Digital rectal examination 4. Prostate specific antigen (PSA; tumor marker, >4 ng/ml abnormal)