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UROLOGY SUB DIVISION

DEPARTMENT OF SURGERY
MEDICAL SCHOOL
UNIVERSITY OF SUMATERA UTARA

I. RENAL TUMORS
A. Grawitz Tumor
B. Wilms Tumor
ll. UPPER URINARY TRACT.
TUMORS
(Pelvio-calyces system &
Ureter)
III. BLADDER TUMORS
IV. TESTICULAR TUMORS
V. PROSTATE CANCER
VI. PENILE CANCER

RENAL
TUMORS

A. Simplified classification of renal tumors:


Benign tumors cystic lesion, oncocytoma,
angiomyolipoma (AML)
Malignant :
- Nephroblastoma (Wilms tumor)
- Renal Cell Ca (adenocarcinoma, hypernephroma)
B. Renal masses classified by pathology of Renal Tumors

c. Renal masses classified by radiographic


appearance
Simple cyst
Complex cyst
Fatty tumors (AML)
All others:
- Oncocytoma
- Renal cell ca ect.

A benign renal neoplasm


It is composed of variable amounts of fat,
vascular, and smooth muscle elements
The fat density of the tumour on CT has been
regarded to be pathognomonic
It occurs in more than 50% of individuals with
tuberous sclerosis, often bilaterally.
Angiomyolipomata also occur in 40% of women
who have a rare, cystic lung disease called
lymphangioleiomyomatosis, or LAM.

Tumor < 4 cm can be observed


Nephrectomy in patients with acute or
potentially life-threatening hemorrhage
Selective embolization in patients with
bilateral disease

3% of all adult malignancies


Male: Female: 3 : 2
6th and 7th decade of life, uncommon in childhood
Renal cell carcinoma arise from the renal
epithelium and account for about 85 percent of
renal cancers
A quarter of the patients present with advanced
disease, (mRCC)
A third of the patients who undergo resection of
localized disease will have a recurrence

Incidental findings on USG


Symptoms : - Hematuria
- Flank pain
- Abdominal/flank mass
Others: Varicocelle / Lower extremity oedema
Para-neoplastic symptoms:
Increased LED / LDH / Ca+
Unexplained fever

CBC, metabolic panel (ESR, LDH, Ca + )


Urinalysis
Abdominal/pelvic ultrasound / CT or MRI with or
without contrast depending on renal function
Chest imaging
Bone scan, if clinically indicated
Brain MRI, if clinically indicated
If urothelial carcinoma suspected, consider urine
cytology, URS or retrograde pyelography
Consider needle biopsy, if clinically indicated

Clear cell / conventional

70 -

80%
Papillary

10 - 15%

Chromophobic

4 - 5%

Collecting duct

< 1%

Medullary cell

< 1%

Oncocytoma

3 - 7%

Treatment :
Nephron-sparing surgery
Radical Nephrectomy
Chemotherapi
Immunotherapi

Lung 29 54 %
Bone 16 - 27 %
Liver 2 - 10 %
Brain 1 7 %

About 5-7% of all renal tumors


90% are TCC, 9% squamous cell ca
TCC of the renal pelvis is 3-4 times more
frequent than TCC of the ureter
: = 3-4 : 1
Incidence increases with age, peaks
during 6th - 7th decades
50% of ureteral tumors are multicentric
5-years overall survival rate is
significantly related to tumor stage

Risk factors:
Chronic infection
Longstanding stone
Analgesic abuse
Smoking
Occupation (chemical, petroleum, plastic,
coal, asphalt)
Exposure to cyclophosphamide (alkylating
agent)

Diagnostic:
History: hematuria, pain/colic
Urine cytology
Imaging: KUB/IVU, CT Scan
Endoscopy: RPG, Cystoscopy, URS
(biopsy prn)
Staging: Chest X-ray, Bone Scan

Ureterectomy (resection &


anastomosis) in selected cases
whenever possible
Nephro-ureterectomy
Endoscopic management
Instilation therapy

Most common malignancy of the urinary


tract
Male > Female
75-85% of patients with bladder cancer
present with disease confined to the
mucosa
The average age at diagnosis is 65 years

Aromatic amines
Smoking
Trauma to the urothelium induced by
infection,
instrumentation, and calculi
Genetic

TCC
SCC

Adeno Ca

Sarcoma

PUN LMP

Undifferentiated

Unknown

90 %
5 10 %
2%

Symptoms:

Hematuria 85 90 %
dysuria,frequency, urgency

Diagnosis:
Urine cytology
Imaging: USG / KUB & IVU / CT-SCAN
Cystoscopy/TUR & biopsy:
- Tumor size
- Location / single or multiple
- Tumor base biopsy

Based on:

Tumor type/grade/stage/size
Primary/recurrence
Location
Focality
Co-morbidity

Intra vesical Chemotherapi


Transurethtral Resection of Baldder Tumor
Radical Cystectomi
Radiotherapi
Chemotherapi

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