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