URINARY TRACT TUMORS

PROSTATE CARCINOMA

Presenter
Ummi Solehah Khairul Anwar
 INTRODUCTION
• Most common malignant tumor in men over 65 y/o.
• Most prostate cancers are slow growing.
• Cancer cells may spread from the prostate to other area of
the body, particularly the bones and lymph nodes.
 PATHOLOGY
• Arising from the peripheral zone
• Usually adenocarcinoma
• Gleason Scoring – degree of
glandular differentiation and
relationship to stroma.
Spread
 Local : grow upwards to seminal
vesicle, bladder & ureter (rectum-
rare)
 Bloodstream : bone
(osteosclerotic) – lower lumbar
and pelvic
 Lymphatics : along int. iliac vein
 ext. iliac node 
retroperitoneal  mediastinal 
supraclavicular
 STAGING (TMN)
TUMOR
 T1 : Clinically inapparent NODAL
tumor neither palpable nor
visible by imaging N1 : Lymph node
 T2 : Tumor confined within metastasis
prostate
 T3 : Tumor extends through
the prostate capsule
 T4 : Tumor is fixed or invades METASTASIS
adjacent structures other
than seminal vesicles : M1 : distance
bladder neck, ext. sphincter,
rectum, levator muscle, metastasis
and/or pelvic wall.
 HISTORY
Age Advanced
• Predominantly a disease of • Symptoms of bladder
elderly. outflow obstruction (BOO)
• Bone pain, malaise, arthritis
Early • Anaemia or pancytopenia
• Asymptomatic symptoms
• Incidental – raised PSA • Renal failure symptoms
• Nodal metastasis – pedal,
penile, genital edema
 PHYSICAL EXAMINATION
1. Sign of anaemia
2. Palpable bladder – urinary
retention

Rectal examination
T1 : normal or smoothly enlarged prostate

T2 : nodular, asymmetrical surface

T3 : Large, hard, irregular gland with extension beyond the

capsule or into the seminal vesicles.

T4 : fixed to the bone or adjacent pelvic organs

 INVESTIGATIONS
DIAGNOSTIC ROUTINE
1. Prostate biopsy (transrectal) 1. Full blood count
o Around 10 biopsy taken o Leuco-erythoblastic anaemia (marrow
o If patient has BOO symptoms, then can do infiltration)
Transurethral Resection of Prostate (TURP) o Anaemia due to renal failure

2. Prostate specific antigen 2. Liver function test

o 10nmol-1 : suggest carcinoma o Liver metastasis (raised ALP)
o 35nmol-1 : advanced ca
o Measure response to treatment. 3. Chest X-ray
o Lung mets
3. Trans-rectal ultrasound (TRUS)
o Local infilteration 4. Abdominal X-ray
o Sclerotic lesion of lumbar vertebrae

5. Bone scan
o If PSA > 10nmol-1
Transperineal biopsy Transrectal biopsy

TURP
 TREATMENT
SURGERY
• RADICAL PROSTECTOMY :
removal of whole prostate until
the distal sphincter and
seminal vesicle.
• Two approaches
 Suprapubic (lower midline
incision below pubic
symphysis)
 Perineal (transverse incision
between scrotum and anus) –
reduce blood loss and faster
convalescence

COMPLICATION
- Impotence
- Stress incontinence
RADIOTHERAPY ANDROGEN ABLATION
• External beam – T1, T2, • Orchidectomy –
locally advanced T3 bilateral, subscapular
• Brachytherapy – T1 • Medical :
disease (Iodine-125 and  LHRH agonist
Palladium-103) (goserelin)
• General RT : for  Anti androgen
metastasis (especially (flutamide,
bone). Eg: strontium bicalutamide,
cyproterone)
 TREATMENT SUMMARY

At any stage, transurethral

resection for BOO

Stages T1 and T2
Stage 3
- Active monitoring or radical
- Radiotherapy
local treatment

Stage 4
- Anti androgen therapy + RT (painful bony metastases or spinal cord
compression) or drug treatment with LHRH agonist/anti-androgen drug
RENAL CELL
CARCINOMA
(Hydronephroma=Grawitz’s tumour)

‘ASYURA BINTI MOHD. REZA

 INTRODUCTION
• Adenocarcinoma
• The most common neoplasm of kidneys (75%)
• Arises from renal tubular cells
• Common in men
 PATHOLOGY

1) The cut surface : usually yellowish/dull white, semi-transparent with

areas of hemorrhage.
2) Tumour is often divided into lobules, some are cystic.
3) Larger tumour : irregular in shape with central hemorrhage and necrosis.
 MODE OF SPREAD
• Local spread: renal vein
• Distant spread : bone
• Hematogenous spread : through inferior vena
cava  lungs (Cannonball appearance)
• Lymphatic spread : para aortic lymph nodes
and beyond (only when the tumor breach
Gerato’s fascia)
 CLINICAL FEATURES
• Asymptomatic in the beginning
• Triad of loin pain, loin mass & hematuria (10%) 
indicate advanced disease
• Hematuria : the most common complaint
• Left vericocele when tumour spread to left renal
vein
• Metastases symptoms : bone pain, chronic
cough, hemoptysis
• Atypical symptoms : persistent fever, cachexia,
anaemia, polycythaemia, hypertension, nephrotic
syndrome
STAGING
 INVESTIGATIONS
INITIAL TEST
TEST REASON
Full blood count Anaemia, polycythaemia
Renal profile Assess remaining renal function
ESR Increased in RCC
Serum calcium Hypercalcaemia (Paraneoplastic syndrome)
Coagulation Pre-surgery investigation
profile
Liver function - Impaired in metastases or
test Paraneoplastic syndrome
- ALP increase in bone metastases

Chest x-ray Cannon ball appearance (liver metastases)

TEST TO CONFIRM DIAGNOSIS & STAGING
TEST REASON
Transabdominal ultrasound - To look for origin of mass, cystic/solid
- Sign of metastases in liver and lymph
node enlargement
Contrast CT scan of abdomen - For TNM staging
- Demonstrate the extent of lesion
MRI of abdomen If renal function is impaired in order to
permit contrast
Transesophageal If suspected spread of tumour from IVC
echocardiogram involving right atrium
Excretory urography Able to assess renal function and any filling
defect indicating presence of mass
PET scan Most sensitive but not widely available
 TREATMENT
• RCC responds poorly to radiotherapy or
conventional chemotherapy.
• Immunotherapy of cytokine IL-2 shows some
benefits but still not widely recommended.

Mainstay of treatment : Nephrectomy

Partial/ complete nephrectomy and removal of
ureter and a cuff of bladder
Types of approach:
- loin
- transabdominal
 PROGNOSIS
• 70% of patients : well after 3 years post-
nephrectomy
• 60% of patients : well after 5 years post-
nephrectomy
WILMS TUMOR
By Nuzul Alimi
Introduction
 Wilms tumor, also known as nephroblastoma, is
a cancer of the kidneys that typically occurs
in children, rarely in adults.
Introduction

Wilms tumor is the most common childhood renal tumor,accounting for

approximately 6 % off all pediatric malignancies

This tumor tends to occur between ages 1 and 3 years

The incidence of wilms tumor is 1 in 10000 children

HISTOLOGY
EMBRIONAL RENAL
NEOPLASMA

BLASTEMAL

STROMAL

EPITHELIAL
CELLS
Histology
Wilms tumors may be separated into 2 prognostic
groups based on pathologic characteristics:
 Favorable - Contains well developed components
mentioned above
 Anaplastic - Contains diffuse anaplasia (poorly

developed cells)
Sign and symptoms
Typical signs and symptoms of Wilms tumor include the following:
 a painless, palpable abdominal mass

 loss of appetite

 abdominal pain

 Constipation

 SOB

 fever

 nausea and vomiting

 blood in the urine (in about 20% of cases)

 high blood pressure in some cases (especially if synchronous or

metachronous bilateral kidney involvement)
Diagnosis
 Chest radiography  detect pulmonary metastatis
 Abdominal radiography linear calcification
 Ultrasound  characteristic of the
mass,intravascular involment
 Ct scan of abdomen
 Biopsy(not typically performed due to seeding of
malignant tissue into abdomen) type of tumour
tissue.
Abd x ray
Diagnosis
Staging
Treatment
The main types of treatment are:
 Surgery-nephrectomy

Remove the tumour.

 Chemotherapy

 radiation therapy

Prognosis :
The overall 5-year survival is estimated to be approximately
90%
In case of relapse of Wilms tumor, the 4-year survival rate for
children with a standard-risk has been estimated to be 80%