NeoplasmsofGenitourinarySystem泌尿系肿瘤教材幻灯片.pptVIP

Staging: TNM System Histopathology（组织病理学） Transitional cell carcinoma（移行细胞癌）90% Nontransitional cell carcinoma: adenocarcinoma, squamous cell Ca, undifferentiated Ca Clinical Findings A. Symptoms: hematuria 85~90% irritative voiding symptoms B. Signs: Majority of patients have no pertinent physical signs. Clinical Findings C. Lab tests: urine test——hematuria urinary cytology——depend on grade and volume of the tumor other markers: BTA, NMP22, telomerase（端粒酶） Clinical Findings D. Imaging: Ultrasonography—screen IVU—evaluation of upper urinary tract CT/MRI—assessment of the depth of infiltration and pelvic LN enlargement E. Cystoscopy（膀胱镜） Ultrasonography of Bladder Ca IVU of Bladder Tumor * Neoplasms of Genitourinary System泌尿系肿瘤 Adenocarcinoma of the Kidney （ Renal Cell Carcinoma, RCC, 肾细胞癌） RCC In US(1999), 30,000 new cases diagnosed, 11,900 deaths from this disease RCC accounts for 3% of adult cancers, 85% of all primary malignant renal tumors RCC occurs most commonly in 5th~6th decade, male-female ratio 2:1 Etiology Cause: unknown Risk Factors: cigarette smoking, exposure to asbestos （石棉）and tanning（鞣革）products Etiology RCC occurs in 2 forms: --inherited（遗传）：chromosome translocation, Von Hippel-Lindau disease --sporadic（散发） Pathology RCC originates from the proximal renal tubular epithelium. Types: Clear cell type Granular cell type Mixed cell type RCC is most often a mixed adenocarcinoma（腺癌）. Tumor Staging (Robson System) I: Tumor is confined within the kidney parenchyma. II: Tumor involves the perinephric fat but confined within Gerota’s fascia (including the adrenal). IIIA: Tumor involves the main renal vein/inferior vena cava. Tumor Staging (Robson System) IIIB: Tumor involves regional LN. IIIC: Tumor involves both local vessels and LN. IVA: Tumor involves adjacent organs other than the adrenal. IVB: Distant metastases. Clinical Findings Symptoms Signs A. Classical triad——gross hematuria, flank pain,