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

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

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

RENAL CELL CARCINOMA

T-

Primary tumour
TX
Primary tumour cannot be assessed
T0
No evidence of primary tumour
T1
Tumour < 7 cm, limited to the kidney
- T1a Tumour < 4 cm.
- T1b Tumour > 4 cm but < 7 cm
T2
Tumour > 7 cm
T3
Tumour extends into major veins or adrenal gland or
perinephric tissues but not beyond Gerotas fascia
- T3a Tumour directly invades adrenal gland or perinephric
tissues1 but not beyond Gerotas fascia
- T3b Tumour extends into renal vein, or the vena cava
below the diaphragm
- T3c Tumour extends into vena cava above diaphragm
T4 Tumour directly invades beyond Gerotas fascia

RENAL CELL CARCINOMA

N - Regional lymph nodes

NX
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastasis
N1
Metastasis in a single regional lymph node
N2
Metastasis in more than 1 regional lymph node
pN0 lymphadenectomy 8 or more lymph nodes are
negative.
M - Distant metastasis
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

RENAL CELL CARCINOMA

TNM stage grouping

Stage I
Stage II
Stage III
Stage IV

T2
T3
T1, T2, T3
T4
Any T
Any T

T1
N0
N0
N1
N0,N1
N2
Any N

N0
M0
M0
M0

M0

M0
M0
M1

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

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 6 th 7th decades
50% of ureteral tumors are multicentric
5-years overall survival rate is significantly
related to tumor stage

Risk factors :
Chronic infection
Long standing 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

Sarcoma
PUN

LMP

Undifferentiated
Unknown

2%

BLADDER CANCER

T - Primary tumour
TX
Primary tumour cannot be assessed
T0
No evidence of primary tumour
Ta
Non-invasive papillary carcinoma
Tis
Carcinoma in situ: flat tumour
T1
Tumour invades subepithelial connective tissue
T2
Tumour invades muscle
T2a Tumour invades superficial muscle (inner half)
T2b
Tumour invades deep muscle (outer half)
T3
Tumour invades perivesical tissue:
T3a
Microscopically
T3b
Macroscopically (extravesical mass)
T4
Tumour invades : prostate, uterus, vagina, pelvic wall,
abdominal wall
T4a
Tumour invades prostate, uterus or vagina
T4b
Tumour invades pelvic wall or abdominal wall

BLADDER CANCER

N - Lymph nodes
NX
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastasis
N1
Metastasis in a single lymph node 2 cm or less
in greatest
dimension
N2
Metastasis in a single lymph node more than 2
cm but not
more than 5 cm in greatest
dimension, or multiple lymph
nodes, none more
than 5 cm in greatest dimension
N3
Metastasis in a lymph node more than 5 cm in
greatest
dimension

BLADDER CANCER

M - Distant metastasis
MX
Distant metastasis cannot be assessed
M0
No distant metastasis
M1
Distant metastasis

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