泌尿系统肿瘤 Urological Carcinoma.ppt

Pathology Grading and Staging The Gleason grading system is the most commonly employed Gleason Score (Gleason et al, 1974) (Primary score and secondary score) Well-differentiated tumors—2-4 Moderately differentiated tumors—5-6 Poorly differentiated tumors—7-10 Clinical Findings Clinical Findings Clinical Findings Clinical Findings Clinical Findings Clinical Findings Clinical Findings Clinical Findings Treatment Treatment Treatment Treatment Treatment Before Treatment Before Treatment After Orchiectomy E C T Pathology * Treatment Standard therapy—nephroureterectomy Retroperitoneal laparoscopic Instillation of immuno agents—BCG Chemotherapeutic agents—mitomycin C Nephroureterectomy Nephroureterectomy Tumors of the penis Poor hygiene Unheard of in males circumcised near birth Smegma accumulation under the phimotic foreskin results in chronic inflammation leading to carcinoma Pathology Precancerous lesions— a white plaque Carcinoma in Situ—Bowen Disease squamous cell carcinoma in situ –red plaque Squamous cell carcinoma—the majority 1. Papillary 2. Ulcerative Clinical Finding Symptoms: Diagnosis Treatment Carcinoma in situ—laser treatment Partial penetomy—2-3cm margin from normal Total penetomy—insufficient length for sex Radiation—no significant effect Chemotherapy—good bleomycin, methotrexate, cisplatin, and 5-FU Prognosis Presence or absence of nodal disease 5-year survival rate: Tumor of the penis Tumor of the penis Tumor of the Testis Causes The cause of testicular cancer is unknown Classification Germ cell tumors 90-95% Non-germ cell tumors 5-10% Classification Germ cell tumors Classification Seminoma Classification Non-seminoma Embryonal cell carcinoma (20%) Two types a. Embryonal cell carcinoma—adult b. Yolk sac tumor—infants and children (endodermal sinus tumor) Classification Teratoma (5%)—both children and adults Choriocarcinoma (1%) Pure chorioca