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Genito-Urinary TumorsGenito Urinary Tumors
Bladder TumorsBladder TumorsCarcinoma of the prostatep
Testicular Tumors
Prof. H.Farsi 0505620033
Pager:2402
Dr. H. Farsi
Ref.: Current Surgical Diagnosis & Treatment
• ALL MY CLINICAL TEACHING WILL BE IN THE ESWL UNIT.
• WHERE IS THE ESWL UNIT?WHERE IS THE ESWL UNIT?• IT IS IN THE BASEMENT OF THE CLINIC
BUILDING BESIDE THE DIALYSIS UNITBUILDING, BESIDE THE DIALYSIS UNIT, AND NOT THE HOSPITAL BUILDING.
• Sunday: Starts at 08:300Wednesda : Starts at 09:00• Wednesday: Starts at 09:00
• Please Note: NO STUDENT IS ALLOWED TO JOIN IF HE/SHE IS MORE THAN 15 min Late.
Dr. H. Farsi
min Late.
Bladder Tumor
Dr. H. Farsi
Epidimiology
• 2nd most common GU tumor• M:F=2:1• 60 65y• 60-65y• Multifocal• Tendency for recurrence
Dr. H. Farsi
Risk Factors
• Industrial carcinogensP t h i l bb
• SchistosomiasisP l d h i i– Petrochemicals, rubber,
leather, paint
• Cigarette smoking
• Prolonged catheterization• Neglected bladder stones
Cigarette smoking• Artificial sweeteners??• Phenacitin and analgesicPhenacitin and analgesic
abuse• Cyclophosphamidey p p• Oncogenic virus
Dr. H. Farsi
Clinical PictureCli i l Pi• Clinical Picture:
1) Hematuria, microscopic or gross.2) Irritative symptoms (? Cystitis), e.g. dysuria, frequency, urgency etc.3) Incidental: Urine, X-Ray, cystoscopy
• Signs:– MetastasisMetastasis– Uremia
• Urine:– Analysis: RBCs, WBCs– Urine tumor markers– CytologyCytology
• Radiological tests:1) IVP2) Pelvic US3) CT or MRI
Dr. H. Farsi
IVPIVP
Filling Defect
Dr. H. Farsi
Ultrasound
Dr. H. Farsi
CT Scan
Dr. H. Farsi
• Cystoscopy & Biopsy
Dr. H. Farsi
Bimanual Examination
Dr. H. Farsi
Pathologygy• Histology
i h li l– Epithelial• Transitional cell• Squamous cell• Adenocarcinoma• Undifferentiated
– Nonepithelialp• Grade ( differentiation)
L l f i i• Level of invasion
Dr. H. Farsi
TAS fi i l
T 1Superficial
T 2
T 3Deep
T 4
Dr. H. Farsi
Metastasis
– L.N.– Lung
Liver– Liver– ??? Bone
Dr. H. Farsi
Treatment of Transitional CellTreatment of Transitional Cell TumorTumor
1. Surgery:TransUrethral Resection of Bladder Tumor (TURBT)Radical Cystectomy
2. Radiotherapy3 Systemic chemotherapy3. Systemic chemotherapy4. Local chemotherapy5 L l i h (BCG)5. Local immunotherapy (BCG)
Dr. H. Farsi
….continue treatment
S fi i l T• Superficial Tumor– TURBT+single dose intravesical chemo– Recurrence:
• TURBT:Local chemotherapy– Local chemotherapy
– Local immunotherapy (BCG)
• Deep Tumor:Deep Tumor:– Radical cystectomy– Radiotherapy– Radiotherapy
• Metastatic Tumor:P lli ti– Palliative surgery
– Palliative careS i h h
Dr. H. Farsi
– Systemic chemotherapy
Diversion
Dr. H. Farsi
Ca Prostate
Dr. H. Farsi
Epidimiology• The most common cancer in western men• Elderly men >50• Elderly men >50• No relation to BPH• Etiology:
– Genetic– Environment– Hormones– Diet– Chemicals– Virus
Dr. H. Farsi
DiagnosisDiagnosis• Clinical Picture:Clinical Picture:
– Asymptomatic:• PR, PSA
S– Sympyoms:• LUTS ( Lower Urinary Tract Symptoms)• HematuriaHematuria• Symptoms of metastasis• Symptoms of uremia
– Signs:• PR• Signs of metastasis or uremiaSigns of metastasis or uremia
• Tumor markers: PSA, PAP• Biopsy
Dr. H. Farsi
• Biopsy
Pathology• Histology:
– Adenocarcinoma– Transitional Cell Carcinoma– Squamous Cell Carcinoma– Sarcoma (Rhabdomyosarcoma)
• Grade:– Gleason(1-10)( )
• Level of Invasion
Dr. H. Farsi
Staging
h dDr. H. Farsi
N= Lymph nodesM= Distant metastasis
Metastasis
– L.N.– Bone
Liver– Liver– Lung
Dr. H. Farsi
Staging
• TransRectal UltraSound (TRUS)• CT pelvis or MRI• Bone scan or Skeletal survey• Bone scan or Skeletal survey• Chest X-ray• US liver
Dr. H. Farsi
Dr. H. Farsi
Bone ScanBone Scan
Skeletal Survey
Dr. H. Farsi
TreatmentTreatment• Localized:
– Radical prostatectomy– RadiotherapyRadiotherapy– Brachytherapy
• Metastatic:• Metastatic:– Palliative care
Hormonal treatment:– Hormonal treatment:• Orchaiectomy, LH-RH agonist, estrogens, antiandrogens
Dr. H. Farsi
Testicular Tumors
Dr. H. Farsi
Epidimiology
• Rare• The most common malignancy in young
malemale• 20-40y• Right> Left• UDT= 40 times ( S rger does not alter the malignant potential)• UDT= 40 times ( Surgery does not alter the malignant potential)
Dr. H. Farsi
Clinical PictureClinical Picture• Symptoms:y p
– Painless testicular mass– Hydrocele– Back pain– Dyspnia– Incidental
• Signs:i l ( f idid i )– Testicular mass (separate from epididymis)
– Not tenderH d l– Hydrocele
– Abdomenal or neck mass
Dr. H. Farsi
Histology• 1ry:
– Germinal:Germinal:• Seminoma• Nonseminoma:Nonseminoma:
– Embryonal Cell Carcinoma– Teratoma– Choriocarcinoma– Yolk sac tumor– Mixed Cell TypeMixed Cell Type
– Nongerminal:• Leydig Cell, sertoli cell, gonadoblastomaLeydig Cell, sertoli cell, gonadoblastoma
• 2ry: Lymphoma, leukemia
Dr. H. Farsi
Investigation
• Laboratory:– Renal profile– LFT– Tumor markers: B-
HCG, alfa-fetoprotein
• Radiological tests:– Scrotal US– CT abdomen– Chest X-Ray
Dr. H. Farsi
TreatmentTreatmentIF YOU SUSPECT TESTICULAR TUMOR:
NEVER EVER TAKE A BIOPSY THROUGH THE SCROTUMTHROUGH THE SCROTUM
Dr. H. Farsi
Testicular Tumor:Radical Orchaiectomy
Seminoma Nonseminoma
Non-metast. Metastatic Non-metast.Metastatic
Chemo Radiother. Chemo RPLND
Dr. H. Farsi