Suspected Malignancy

B9402030 陳建佑

Symptoms

• Red Urinary

• Hesitance Urination

Renal Cell Carcinoma

• Site ： kidney• Risk factors ：

1. Cigarette smoking (X2 risk, 1/3 cause of RCC)2. Obesity (particularly in women3. Hypertension4. Phenacetin-containing analgesia taken in large amounts5. Acquired cystic disease of the kidney in patients undergoing long-term renal dialysis6. Tuberous sclerosis 7. Renal transplantation8. VHL disease (Deletions of 3p )

Renal Cell Carcinoma

• Symptoms ： Most common presentations Hematuria (40%) Flank pain (40%) Palpable mass in the flank or abdomen (25%) Other signs and symptoms: Weight loss (33%) Fever (20%) Hypertension (20%) Hypercalcemia (5%) Night sweats Malaise

Renal Cell Carcinoma

• Diagnostic approaches ：1. Intravenous pyelogram (IVP)2. Ultrasound exam3. CT scan4. MRI

Tumor Markers

• CD10 and RCC Often expressed by clear cell renal cell carcinomas, and they may be useful markers to suggest a renal origin of carcinomas.

• Ferritin Higher levels in the renal vein, its positive correlation with tumor size and volume suggest that ferritin is expressed by RCC. Initial peripheral serum values of ferritin can be indicative of disease status and also be a prognosticator of survival.

Radiography of RCC• line is caused by the

natural contrast provided byretroperitoneal fat lying against the psoas muscle

• Black spot indicates that the mass is retroperitoneal because it has dispalecd the retroperitoneal fat and now there is a water density soft tissue mass adjacent to the water density psoas and thus no visible boundary between them .

CT of RCC

Ultrasound of RCC

• Dark grey(hypo-echoic) cortex surrounding light grey(hyper-echoic) medulla. A solid mass (arrow) of slightly greater echogenicity than renal cortex is seen arising from the kidney.

MRI of RCC

Renal Pelvis & Ureter Cancer

• Risk Factors ：1. Analgesic nephropathy2. Exposure to certain dyes and chemicals used to manufacture leather goods, textiles, plastics, and rubber3. Smoking

• Symptoms ：1. Back pain, located where ribs and spine meet 2. Bloody urine / Dark, rust-colored, or brown urine 3. Burning, pain, or discomfort with urination 4. Fatigue, Unintentional weight loss 5. Nocturnal urinary 6. Urinary frequency or urgency but hesitancy

Renal Pelvis & Ureter Cancer

• Diagnostic approaches ：1. Rare mass or enlarged kidney in PE2. Urine cytology3. The tumor or signs of urinary obstruction, may appear on: a. Abdominal CT scan b. Intravenous pyelogram (IVP) c. Kidney ultrasound d. MRI of abdomen e. Renal scan

Radiography

• Left anterograde pyelography showing a filling defect approximately 3 cm in diameter suggesting an urothelial neogrowth.

CT

• Tumor occupying the right ureter lumen with thickening of ureteral wall.

Bladder Cancer

• Risk Factors ：1. Exposure to chemicals 2. Cigarette smoke (X6~10) 3. Family history

• Symptoms ：1. painless and intermittent Hematuria (1.5%)2. Flank, perineum pain; (flank region complete or partial blockage of the ureter on that side, with the pain being due to back pressure of urine.)3. Voiding symptoms4. Bodywide symptom

Bladder Cancer

• Diagnostic approaches ：1. Urinalysis, Urine cytology2. IVP (intravenous pyelogram)3. CT scan4. Cystoscopy & biopsy

Tumor Markers

• BTA (Bladder Tumor Antigen)1. Won’t present when normal2. False Positive when a. Recent invasive procedure b. Infection genitourinary tract c. Cancer of kidney, ureters

• NMP 221. Normal <10 ng/ml2. False Positive when a. Chemotherapy b. Benign GU disease, renal/bladder stone

IVP

CT

Cystoscopy

Prostate Cancer

• Risk Factors ：1. Genetic2. Diet; high trans-fat, low Vit E & selenium 3. Medication Exposure; anti-inflammatory medicine :aspirin,ibuprofen4. Infection; chlamydia, gonorrhea, or syphilis

• Symptoms ：1. Early state usually causes no symptoms. elevated PSA noticed during a routine checkup2. Frequent urination3. Increased urination at night 4. Difficulty starting of urine 5. Blood in the urine 6. Painful urination 7. Difficulty achieving erection or painful ejaculation

Prostate Cancer

• Diagnostic approaches ：1. molecular test cell-associated PCA3 mRNA in urine 2. Prostasomes3. Digital rectal examination 4. Prostate specific antigen (PSA; tumor marker, >4 ng/ml abnormal)