DEPARTMENT OF UROLOGY SCHOOL OF MEDICINE BAHÇEŞEHİR UNIVERSITY Renal Tumors Benign Oncocytoma Renal cell adenoma Malignant Renal cell carcinoma Wilms tumor Urothelial carcinoma Renal Cell Carcinoma ID: 1009255
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1. Renal TumoursPROF. DR. METE KİLCİLER DEPARTMENT OF UROLOGY, SCHOOL OF MEDICINE, BAHÇEŞEHİR UNIVERSITY
2. Renal TumorsBenign:OncocytomaRenal cell adenomaMalignant:Renal cell carcinomaWilms tumorUrothelial carcinoma
3. Renal Cell Carcinoma (RCC)
4. RCC accounts for 2% to 3% of all adult malignant tumoursThe most lethal urologic cancer RCC occurs most commonly in 5th~6th decade, male-female ratio 2/1
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7. EtiologyMajority of RCC occurs sporadicallyTobacco smoking Exposure to cadmium, asbestosObesityChronic phenacetin or aspirin use Acquired polycystic kidney disease due to dialysis
8. 2-4% of RCC associated with inherited disorder Von Hippel-Lindau disease Hereditary papillary renal cancerEtiology
9. US Yearly Kidney and Renal Pelvis Cancer Incidence and Mortality
10. RCC Statistics3rd most common genitourinary cancer after prostate cancer and bladder cancerMedian age at diagnosis: 65 years in USMedian age at death: 71 years in US
11. PathologyRCC originates from the proximal renal tubular epithelium.Types: Clear cell type Granular cell type Mixed cell typeRCC is most often a mixed adenocarcinoma.
12. Clinical FindingsSymptoms & Signs Renal tumors are increasingly detected incidentally by CT or ultrasound Classical triad——gross hematuria, flank pain, palpable massSymptoms secondary to metastatic disease: dysnea & cough, seizure & headache, bone pain
13. Common systemic symptomsParaneoplastic symptomsHypertensionCachexiaWeight lossPyrexiaNeuromyopathyAmyloidosisElevated erythrocyte sedimentation rateAnemiaAbnormal liver functionHypercalcemiaPolycythemiaPain or mass related to metastatic disease Clinical Findings
14. Physical ExaminationPlays a limited role in diagnosing RCCMay be valuable in situations where there isA palpable abdominal massA palpable cervical lymphadenopathyBilateral lower extremity edema suggestive of venous involvementAny of the above findings warrants radiologic examination
15. Clinical FindingsD. ImagingUltrasonographyIntravenous Urography (IVU): CT scanning:Renal AngiographyMRI
16. Diagnosis No screening for the general populationNo bio-marker availableRadiographic evaluation
17. IVU of right RCCCT Scan of Left RCC
18. RCC invading renal veinRigh Cystic RCC
19. CT scan with 3D reconstructionNeovascularity in Renal Angiographyassociated with RCC
20. Tumor Staging (Robson System)
21. Tumor Staging (International TNM Staging System)
22. Tumor Staging
23. TreatmentA. Localized disease:Surgical removal---only potentially curative therapyRadical Nephrectomy (en bloc removal of the kidney and Gerota’s fascia including ipsilateral adrenal, proximal ureter, regional lymphadenectomy)
24. Laparoscopic Radical NephrectomyHand-Assisted Laparoscopic Radical Nephrectomy
25. TreatmentA. Localized disease:Partial Nephrectomy (nephron-sparing surgery, NSS ) --polar tumor --tumor size<4cm --bilateral RCC --solitary kidney
26. TreatmentA. Localized disease:Percutaneous Laparoscopic Cryoablation
27. TreatmentB. Disseminated disease:nephrectomy--- reducing tumor volumeradiation--- radioresistant tumor, chemotherapy--- chemoresistant tumor
28. Oncocytoma
29. Wilms Tumor
30. Wilms Tumor (Nephroblastoma)Most common primary kidney tumor in childrenOccur commonly between 2-5 yearsWT1 gene, WT2 gene
31. Wilms Tumor (Nephroblastoma)Risk with congenital malformation:WAGR syndromeLoss of ch 11p13 (WT1)Aniridia, genetal abnormalities, mental retardationDenys-Drash syndromeLoss of ch 11p13 (WT1)Gonadal dysgenesisRenal abnormalitiesBeckwith-Weidmann syndromeEnlarged body organs (tongue, kideny, liver), adrenal enlargement, hemihypertrophy (body segment enlargement)Ch 11p15.5 (WT2)
32. Wilms Tumor (Nephroblastoma)Clinical:MassCross the midlineHematuriaIntestinal obstructionPrognosis: good2 year-survival: 90%
33. Tumors of collecting systemClinical:Like in bladder TCCPainless hematuria50-70 year, men 3x>womenRisk factorsSmokingIndustrial solvent, hydrocarbons, dyes CystitisSchistosomiasiscyclophosphamide
34. Tumors of collecting systemClinical:High recurrence rateFatal by ureteric obstructionOverall survival 5y: 57%Ureteric carcinoma 5y survival: 10%
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