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Genitourinary Tumors: Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara

This document summarizes various genitourinary tumors. It discusses benign tumors like adenoma, oncocytoma, angiomyolipoma and leiomyoma. It then focuses on renal cell carcinoma/adenocarcinoma of the kidney, nephroblastoma, sarcoma of the kidney, carcinoma of the bladder, urethral cancer, penile cancer, and testicular tumors. For each tumor, it covers aspects like epidemiology, etiology, clinical presentation, diagnosis, pathology, staging and treatment.

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Joice Rumondang
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27 views32 pages

Genitourinary Tumors: Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara

This document summarizes various genitourinary tumors. It discusses benign tumors like adenoma, oncocytoma, angiomyolipoma and leiomyoma. It then focuses on renal cell carcinoma/adenocarcinoma of the kidney, nephroblastoma, sarcoma of the kidney, carcinoma of the bladder, urethral cancer, penile cancer, and testicular tumors. For each tumor, it covers aspects like epidemiology, etiology, clinical presentation, diagnosis, pathology, staging and treatment.

Uploaded by

Joice Rumondang
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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GENITOURINARY TUMORS

Urology Division, Surgery Department


Medical Faculty,
University of Sumatera Utara
BENIGN TUMORS

 Adenoma
 Oncocytoma
 Angiomyolipoma
 Leiomyoma
 Lipoma
 Hemangioma
 Juxtaglomerular tumors
1. Renal adenoma

 The most common benign renal parenchymal


lesion
 Small, well-diff glandular tumors of the renal
cortex
 Asymptomatic
 Should be treated of an early renal cancer
and the patient should be evaluated and
treated appropriately
2. Renal oncocytoma

 3 – 5% of renal tumor, : = 2 : 1
 Gross hematuria & flank pain in < 20%
 Radical nephrectomy is the safest method of
treatment unless other factors argue for a
conservative approach
3. Angiomyolipoma (Renal hamartoma)

 Composed of fat, muscle & blood vessels


 Rare, 4 : 1 
 Acute flank pain or shock due to spontaneous
renal or retroperitoneal hemorrhage
 Asymptomatic tumors < 4 cm  followed
closely with serial imaging
 Symptomatic tumors or > 4 cm  selective
embolization or tumor enucleation by partial
nephrectomy
ADENOCARCINOMA OF THE KIDNEY
(RENAL CELL CARCINOMA)
 3% of adult cancer
 :  = 2 : 1, 5th – 6th decades of life
 racial distribution is equal
 more common in urban settings
 = hypernephroma = clear cell carcinoma =
alveolar carcinoma
 Etiology is unknwon
 Cigarret smoking  strongest risk factor
GRADING & STAGING

 Fuhrman system (I – IV)


 General classification system :
- Robson system
- TNM system
CLINICAL PRESENTATION

 Symptom & sign : Classic triad hematuria,


flank pain and palpable mass
 General symptom : weight loss, fever,
anemia, night sweats
 Paraneoplastic syndrome  Hypercalcemia,
erythrocytosis, hypertension, nonmetastatic
hepatic dysfunction
IMAGING EVALUATION

 Intravenous excretory urography


 Renal sonography
 CT
 MRI
 Angiography
 Radionuclide imaging
TREATMENT
 Localized disease
- radical nephrectomy is gold standard

 Disseminated disease
- surgery
- radiation therapy
- hormonal therapy
- chemotherapy
- radioimmunotherapy
- biologic response modifier
PROGNOSIS
 related to the stage at presentation
 5-yr survival rate for T1  88 – 100%
T2 & T3a  60%
T3b  15 – 20%
with metastatic  0 – 20%
NEPHROBLASTOMA (WILMS TUMOR)

 The most common solid renal tumor of


childhood; 5% of childhood cancer
 3rd year of life, no sex predilection
 Commonly unicentric, occur in either kidney
with equal frequency
 Metastatic is present at diagnosis in 10 – 15%,
with lungs (85-95%) and liver (10-15%) the
most common sites
Clinical findings

 ¾ present with palpable abdominal mass,


smooth and rarely crossing midline
 Abdominal pain, anorexia, nausea &
vomiting, fever, hematuria
 Hypertension (25-60%)
 DD : hydronephrosis
cystic kidneys
treatment

 Surgical
 Radiation
- radiosensitive
- its use complicated by potential growth
disturbances, recognized cardiac, pulmonary &
hepatic toxicities
 Chemotherapy
- chemosensitive neoplasm
- actinomycin D, vincristine, doxorubucin,
cyclophosphamide, etoposide, cisplatin
SARCOMA OF THE KIDNEY

 Rare, 1-3% of all malignant renal neoplasm


 5th decade, alight male predominance
 Flank or abdominal pain, weight loss
 Leiomyosarcoma (50%), fibrosarcoma,
liposarcoma,hemangiopericytomas,
osteogenic sarcoma, malignant schwannomas
 Radical nephrectomy for localized disease
CARCINOMA OF THE BLADDER
 2nd most common urologic malignancy after
prostate ca
 The most common histologic diagnosis is TCC
 60 – 75 % are non invasive, but 10 – 20% will
progress to muscle-invasive
etiologi
 Industrial carcinogens  aniline dyes, naphtylamin
 Tobacco exposure
 Chemotherapeutic agent
 Schistosomiasis
 Pelvic irradiation
 Chronic irritation & infection
 Phenacetin
 Baldder exstrophy
 Coffee  not strong
 Saccharin  in experimental animal
Epidemiology

 Age  6th – 8th decades


 Race  twice in American men
 Gender  : = 3 : 1
 Genetics
 Demography  higher in US compared to
Japan
Symptom
 Hematuria
- gross or microscopic  85% cases
- intermittence is not a reason to exclude an
evaluation
- indicates cancer until proven otherwise
 Irritative voiding symptom  frequency,
dysuria, urgency
 Baldder filling defect on urography
 Unanticipated finding on cystoscopy
Diagnosis

 TUR
 Random bladder & posterior urethral
biopsies
 Urinary cytology
 Flow cytometry
 Tumor markers
Pathology
 Epithelial dysplasia
 Carcinoma in situ
 Superficial TCC  70%
 Muscle invasive TCC
 Squamous cell ca
 Adenoca
 Sarcoma of the bladder
 Small cell carcinoma
treatment
 Superficial bladder cancer
1. TURBT  - initial & standard therapy
2. Laser photocoagulation  less dyscomfort,
minimal bleeding
3. Intravesical therapy
- weekly treatment
- mitomycin C, adriamycin, thiotepa, BCG, interferons
 Muscle invasive TCC
1. radical cystectomy
2. partial cystectomy
3. radiation therapy
4. TUR
5. combined
6. adjuvant therapy
7. metastatic disease  MTX, vinblastine,
adriamycin
8. palliative therapy
URETHRAL CANCER
 CARCINOMA OF THE FEMALE URETHRA
- rare, more common in older
- squamous cell ca is the most prevalent
- most common symptom  urethral
bleeding or spotting
- management :
* distal 3rd  distal urethrectomy or radiation
* proximal  very poor prognosis  anterior
exenteration
CARCINOMA OF THE MALE URETHRA
 Etiologic role  chronic inflammation &
urethral strictures
 The most common is squamous cell
carcinoma
PENILE CANCER
 PREMALIGNANT LESIONS
- Condylomata acuminata
- Buschke-Lowenstein’s tumor
- Leukoplakia
- Balanitis xerotica obliterans
- Bowenoid papulosis

 CARCINOMA INSITU
- Queyrat’s erythroplasia & Bowen’s disease
- Kaposi sarcoma
INVASIVE SQUAMOUS CELL CARCINOMA
 Subtype :
- verrucous carcinoma
- basaloid carcinoma
- spindle cell (sarcomatoid carcinoma)
- penile malignant melanoma
 Etiology  associated with poor hygiene and
exposure to irritans, carcinogens or viral
pathogens
 Clinical features : painless nodule, wart-like
growth, ulceration or vesicle
TESTICULAR TUMOR

 The most common solid tumor in men


between 20 – 34 yrs
 Most curable form of urologic cancer
 Classification : pure seminoma &
nonseminoma
 No definitive cause has been identified
 Testicular maldescent has been associated
with the disease
pathology
 The Dixon-Moore classification :
1. Germinal neoplasms
a. Seminoma
- Classic
- anaplastic
- spermatocytic
b. Embryonal carcinoma
c. Teratoma with or without malignant
transformation
d. Choriocarcinoma
e. Yolk sac tumor
2. Non germinal neoplasms
a. Gonadal stromal tumors : Leydig cell
tumor & gonadoblastoma
b. Miscellaneous neoplasms : carcinoid,
adrenal rests, mesenchymal neoplasms

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