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
Classification of 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
Classification of Renal Tumors (con’t):

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
Renal cell carcinoma:
Initial workup

 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 90 %

 SCC 5 – 10 %

 Adeno Ca 2%

 Sarcoma

 PUN LMP

 Undifferentiated

 Unknown
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