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Urogenital Neoplasms Liping Xie
Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University
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Renal Cell Carcinoma (RCC)
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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
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Etiology Renal Cell Carcinoma (RCC)
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
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Etiology Renal Cell Carcinoma (RCC)
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
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Pathology Types: Renal Cell Carcinoma (RCC)
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.
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Clinical Findings Renal Cell Carcinoma (RCC) 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
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Clinical Findings Renal Cell Carcinoma (RCC)
B. Paraneoplastic Syndromes Erythrocytosis, hypercalcemia, hypertension C. Lab Findings anemia, hematuria (60%), ESR↑
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Clinical Findings Renal Cell Carcinoma (RCC)
B. Paraneoplastic Syndromes Erythrocytosis, hypercalcemia, hypertension C. Lab Findings anemia, hematuria (60%), ESR↑
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Clinical Findings Renal Cell Carcinoma (RCC) 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
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Diagnosis Renal Cell Carcinoma (RCC)
No screening for the general population No bio-marker available Radiographic evaluation
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Renal Cell Carcinoma (RCC)
IVU of right RCC CT Scan of Left RCC
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RCC invading renal vein
Renal Cell Carcinoma (RCC) Righ Cystic RCC RCC invading renal vein
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CT scan with 3D reconstruction
Renal Cell Carcinoma (RCC) CT scan with 3D reconstruction Neovascularity in Renal Angiography associated with RCC
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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.
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Tissue Diagnosis Renal Cell Carcinoma (RCC)
Tissue diagnosis obtained from nephrectomy or biopsy Papillary (chromophilic) renal cell carcinoma extending into the collecting system with histological findings
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Tumor Staging (Robson System)
Renal Cell Carcinoma (RCC) Tumor Staging (Robson System)
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Tumor Staging (International TNM Staging System)
Renal Cell Carcinoma (RCC) Tumor Staging (International TNM Staging System)
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Renal Cell Carcinoma (RCC)
Tumor Staging
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Differential Diagnosis
Renal Cell Carcinoma (RCC) Differential Diagnosis Benign renal tumors -Angiomyolipoma Renal Pelvis Cancer
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Treatment Renal Cell Carcinoma (RCC) 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
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Hand-Assisted Laparoscopic Radical Nephrectomy
Renal Cell Carcinoma (RCC) Hand-Assisted Laparoscopic Radical Nephrectomy Laparoscopic Radical Nephrectomy
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Treatment Renal Cell Carcinoma (RCC) A. Localized disease:
Partial Nephrectomy(nephron-sparing surgery, NSS ) --polar tumor --tumor size<4cm --bilateral RCC --solitary kidney Laparoscopic NSS
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Laparoscopic Cryoablation
Renal Cell Carcinoma (RCC) Treatment A. Localized disease: Percutaneous/Laparoscopic Radiofrequency Ablation or Cryoablation Laparoscopic Cryoablation
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Treatment Renal Cell Carcinoma (RCC) 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
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Prognosis Stage 5-year survival rate I 88~100% II 60% III 15~20%
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Bladder Cancer
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The peak incidence is in persons from 50-70 years
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 years
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Etiology Bladder Cancer Industrial toxins Cigarette smoking
Genetic events Other risk factors cyclophosphamide, alkylating agents, radiotherapy of pelvis.
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Pathology Bladder Cancer Histopathlogy Grading
1.transitional cell carcinoma 90% 2.squamous cell carcinoma % 3.adenocarcinoma % 4.other types Grading Grade mild anaplasia Grade moderate anaplasia Grage marked anaplasia
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Clinical Findings Bladder Cancer A. Symptoms:
Painless Hematuria 85~90% Irritative voiding symptoms B. Signs: The majority of patients have no pertinent physical signs.
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Clinical Findings Bladder Cancer C. Lab tests: Urine test——hematuria
Urinary cytology——depend on grade and volume of the tumor Other markers: BTA, NMP22, telomerase
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Clinical Findings Bladder Cancer D. Imaging: Ultrasonography—screen
IVU—evaluation of upper urinary tract CT/MRI—assessment of the depth of infiltration and pelvic LN enlargement E. Cystoscopy
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Diagnosis Bladder Cancer
Ultrasonography can be used as screening method to detect bladder tumors and upper urinary tract obstruction. both CT and MRI are used to characterize the extent of bladder wall invasion and detect enlarged pelvic lymph node.
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Diagnosis Bladder Cancer 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.
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Ultrasonography of Bladder Ca (Arrow Head)
Bladder Cancer Ultrasonography of Bladder Ca (Arrow Head) IVU of Bladder Tumor
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Bladder Cancer CT scan of bladder Ca
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Cystoscopy of bladder Ca
Bladder Cancer Cystoscopy of bladder Ca
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Bladder Cancer TNM Tumor Staging
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Bladder Cancer TNM Tumor Staging
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Treatment Bladder Cancer Superficial bladder cancer (Ta,T1,Tis)
transurethral resection intravesical chemotherapy or immnotherapy(BCG) cystoscopic surveillance
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Treatment Bladder Cancer 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, M high-risk superficial tumours (T1G3, BCG-resistant Tis) 3.extensive papillary disease Urinary diversion after radical cystectomy
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Bladder Cancer partial cyctectomy
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Bladder Cancer Radical Cystectomy
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Treatment Bladder Cancer 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
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Prostate Cancer
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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
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Risk factor Prostate Cancer 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
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Pathology Prostate Cancer
Over 95% of the cancers of the prostate are adenocarcinomas. Prostatic intraepithelial neoplasia (PIN) high grade (HGPIN) low grade (LGPIN)
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Mostly arise from the peripheral zone of the gland
Prostate Cancer Mostly arise from the peripheral zone of the gland
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Grading Prostate Cancer
the Gleason system is widely used for its best clinical correlation
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Staging Prostate Cancer
Stage I small foci of carcinoma in resection for benign disease Stage II disease confined to prostate Stage III extracapsular extension Stage IV regional lymph node metastases or distant metastases
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Prostate Cancer The TNM staging system
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Clinical Findings Prostate Cancer A. Symptoms
Early stage: asymptomatic Locally advanced/metastatic disease—obstructive or irritative voiding complaints, bone pain, paresthesias and weakness of lower extremities
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Clinical Findings Prostate Cancer B. Signs:
Digital rectal examination—induration
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Clinical Findings Prostate Cancer C. Tumor markers
Prostate Specific Antigen (PSA) < 4 ng/ml normal 4 ~ 10 ng/ml Grey Zone > 10 ng/ml highly suspect of PCa
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Clinical Findings Prostate Cancer D. Imaging
Ultrasonography-hypoechoic lesion Transrectal ultrasonography (TRUS) CT, MRI Bone scan
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Clinical Findings Prostate Cancer E. Prostate biopsy
The golden standard
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Prostate Cancer MRI of prostate cancer
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Prostate Cancer Bone scan
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Treatment Prostate Cancer A. Localized disease
Watchful waiting, older patients with samll, well-differentiated cancer Radical prostatectomy, patients with a life expectency > 10 years Radiation
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Radical Prostatectomy
Prostate Cancer Radical Prostatectomy
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Prostate Cancer
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Treatment Prostate Cancer B. Locally advanced/metastatic diseases
Endocrine therapy—androgen blockade : orchiectomy antiandrogen agent LHRH agonist Radiation Chemotherapy
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Further Reading Renal Pelvis Cancer / Tumor of Ureter Penile Cancer
Testicular Cancer
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Further Reading
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Thank you for your attention !
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