泌尿系肿瘤课件_9

NeoplasmsofGenitourinarySystem泌尿系肿瘤 瑞金医院泌尿外科邵远 AdenocarcinomaoftheKidney RenalCellCarcinoma RCC 肾细胞癌 RCC InUS 1999 30 000newcasesdiagnosed 11 900deathsfromthisdiseaseRCCaccountsfor3 ofadultcancers 85 ofallprimarymalignantrenaltumorsRCCoccursmostcommonlyin5th 6thdecade male femaleratio2 1 Etiology Cause unknownRiskFactors cigarettesmoking exposuretoasbestos 石棉 andtanning 鞣革 products Etiology RCCoccursin2forms inherited 遗传 chromosometranslocation VonHippel Lindaudisease sporadic 散发 Pathology RCCoriginatesfromtheproximalrenaltubularepithelium Types ClearcelltypeGranularcelltypeMixedcelltypeRCCismostoftenamixedadenocarcinoma 腺癌 TumorStaging RobsonSystem I Tumorisconfinedwithinthekidneyparenchyma II TumorinvolvestheperinephricfatbutconfinedwithinGerota sfascia includingtheadrenal IIIA Tumorinvolvesthemainrenalvein inferiorvenacava TumorStaging RobsonSystem IIIB TumorinvolvesregionalLN IIIC TumorinvolvesbothlocalvesselsandLN IVA Tumorinvolvesadjacentorgansotherthantheadrenal IVB Distantmetastases ClinicalFindings Symptoms SignsA Classicaltriad grosshematuria flankpain palpablemass onlyin10 15 advancedcases Symptomssecondarytometastaticdisease dysnea cough seizure headache bonepainRenaltumorsareincreasinglydetectedincidentallybyCTorultrasound ClinicalFindings B ParaneoplasticSyndromes erythrocytosis 红细胞增多症 hypercalcemia 高钙血症 hypertensionC LabFindings anemia hematuria 60 ESR ClinicalFindings D X rayFindings Ultrasonography IntravenousUrography IVU 75 accurate usedalone calcification CTscanning moresensitive mass renalhilum perinephricspaceandvenacava adrenals regionalLNandadjacentorgans RenalAngiography IVUofrightRCC CTscanofrightRCC CTscanofleftRCC RCCinvadingrenalvein LeftcysticRCC LeftcysticRCC DifferentialDiagnosis Benignrenaltumors Angiomyolipoma 血管平滑肌脂肪瘤 错构瘤 Treatment 1 Localizeddisease Surgicalremoval onlypotentiallycurativetherapyRadicalNephrectomy enblocremovalofthekidneyandGerota sfasciaincludingipsilateraladrenal proximal ureter regionallymphadenectomy 淋巴结清扫 Treatment 2 Disseminateddisease nephrectomy reducingtumorburdenradiation radioresistanttumor metastases2 3effectivechemotherapy 10 effectiveimmunotherapy IL 2 interferon alpha 30 responserate Prognosis Stage5 yearsurvivalrateI88 100 II60 III15 20 IV0 20 RenalPelvicCancer 肾盂癌 Incidence rare 3 ofallurothelialcancersPathology transitionalcell90 squamouscell10 ClinicalFindings A Symptoms Signsgrosshematuria70 90 flankpain8 50 B LabFindings hematuria cytology 40 positive tumormarkers BTA NMP22 ClinicalFindings C ImagingIVU intraluminalfillingdefect unilateralnonvisualizationofthecollectingsystem hydronephrosisUS CT MRIUreteropyeloscopy 肾盂输尿管镜 IVUofrightpelvicCa CTscanofrightpelvicCa CTofrightpelvicCa Treatment Standardtherapy nephroureterectomy 肾输尿管全长切除 removaloftheentiredistalureterwithasmallcuffofbladder BladderCarcinoma 膀胱癌 BladderCa Thesecondmostcommoncancerofthegenitourinarysystem male femaleratio2 7 1Initiators Promoters cigarettesmokingoccupationalexposuregeneticevents Staging TNMSystem Histopathology 组织病理学 Transitionalcellcarcinoma 移行细胞癌 90 Nontransitionalcellcarcinoma adenocarcinoma squamouscellCa undifferentiatedCa ClinicalFindings A Symptoms hematuria85 90 irritativevoidingsymptomsB Signs Majorityofpatientshavenopertinentphysicalsigns ClinicalFindings C Labtests urinetest hematuriaurinarycytology dependongradeandvolumeofthetumorothermarkers BTA NMP22 telomerase 端粒酶 ClinicalFindings D Imaging Ultrasonography screenIVU evaluationofupperurinarytractCT MRI assessmentofthedepthofinfiltrationandpelvicLNenlargementE Cystoscopy 膀胱镜 UltrasonographyofBladderCa IVUofBladderTumor CTscanofbladderCa BladderCaundercystoscopy Treatment 1 SurgeryTUR Trans UrethralResection PartialCystectomy 膀胱部分切除 RadicalCystectomy 根治性膀胱全切除 2 Radiotherapy TURofBladderTumor TURBT AfterTUR Treatment 3 IntravesicalChemotherapy 膀胱内化疗 molecularresponseweightrateMitomycinC32939 78 Thiotepa189upto55 Doxorubicin580mean38 BCG36 71 CarcinomaoftheProstateCaP 前列腺癌 CaP ThemostcommoncancerinAmericanmenIncreasesrapidlywithage95 areadenocarcinoma ClinicalFindings A Symptomsearlystage asymptomatic 无症状 locallyadvanced metastaticdisease obstructiveorirritativevoidingcomplaints bonepain paresthesias 感觉异常 andweaknessoflowerextremitiesB Signs DRE induration 硬结 ClinicalFindings C TumormarkersPSA 前列腺特异抗原 ProstateSpecificAntigen20ng mlhighlysuspectofPCa ClinicalFindings D Prostatebiopsy 活检 goldenstandardE ImagingTRUS MRI Bonescan Treatment 1 Localizeddisease optimalformingreatdebating WatchfulwaitingRadi