Tumor Urotel

7/27/2019 Tumor Urotel

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Reinildis Hildegardis Uruk Hane


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Relevant Anatomy

Renal pelvis

The renal pelvis is the portion of the urinary collecting systemformed by the confluence of 2 or 3 major calices.

UreterThe ureter is a 20- to 30-cm tubular structure lying on the psoas

muscle. It follows an S-shaped curve, passing medially to thesacroiliac joint and then coursing laterally near the ischial spinebefore passing medially to penetrate the base of the bladder. It passes

through a submucosal tunnel to empty into the bladder.

HistologyThe renal pelvis and ureter are lined by a transitional epithelium. The

next layer is the lamina propria. External to the lamina propria issmooth muscle arranged in a spiral and longitudinal manner. The

outermost adventitia is composed of fibrous connective tissue.


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FAKTOR RESIKO

Tobacco smoking

Drinking coffee slightly increases the risk ofupper tract TCC

Analgesic abuse Occupational exposure to agents used in

the petrochemical, plastic, and tar

industries Chronic infections, irritation, and calculi

Heredity

http://emedicine.medscape.com/article/452449-overview#a0102
http://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overview


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PATOFISIOLOGI

Types of upper urinary tract tumors Transitional cell carcinoma (TCC) Squamous cell carcinomaAdenocarcinoma Inverted papilloma

Tumor suppressor genes P19, P16, RB1, and P53 have allbeen associated with upper urinary tract TCC. Lossesof P53, P19, and P16 are associated with low-grade

cancers, while a loss of RB1 has been associated withhigher-grade, more aggressive tumors.

http://emedicine.medscape.com/article/452449-overview#a0104
http://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overviewhttp://emedicine.medscape.com/article/452449-overview


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Langkah penegakan diagnosis

Gross or microscopic hematuria (75%)

Flank pain (20%) results from gradualobstruction/distention of the collecting system oracute colic due to obstruction by a blood clot.

Lumbar mass is noted in 10-20%.

Dysuria (6%) is reported; some patients reportirritative lower urinary tract symptomatology such

as burning upon urination. Weight loss, anorexia, flank mass, or bone pain are

symptoms of advanced disease that manifest in aminority of patients.


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Laboratory Studies

Urinalysis

Basic metabolic panel should be ordered tocheck serum creatinine (assess renal function)and electrolytes.

Activated partial thromboplastin time (aPTT),

prothrombin time (PT), and internationalnormalized ratio (INR)


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Intravenous pyelogram (IVP)

Cystoscopy to rule out bladder tumor,

Urinary cytology CT scan -CT urography.


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Grading, based on the 2004 World HealthOrganization (WHO) classification, is asfollows:

Grade 1 - Papillary urothelial neoplasia oflow malignant potential

Grade 2 - Low-grade carcinoma

Grade 3 - High-grade carcinoma


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Langkah penegakan diagnosisStaging, TNM system (2009),

Tis - Carcinoma in situ Ta - Superficial/papillary, noninvasive

T1 - Lamina propria invasion

T2 - Muscularis propria invasion

T3 Peripelvic fat/periureteral fat/renal parenchyma invasion

T4 - Contiguous organ involvement N0 - Negative nodes

N1 - Metastasis in single node less than 2 cm in diameter

N2 - Metastasis in single node 2-5 cm in diameter or metastasis tomultiple nodes less than 5 cm in diameter

N3 - Metastasis in lymph node greater than 5 cm in diameter

M0 - No distant metastasis

M1 - Distant metastasis

The location of the tumor can affect the findings. Renal pelvis tumors are morecommonly invasive than bladder tumors, possibly because of delayed diagnosis and

a less well-developed muscle layer.


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Penatalaksanaan Superficial (Ta, T1) and carcinoma in situ

Primary : agent bacille Calmette-Gurin (BCG)

Adjuvant therapy : Adjuvant topical treatmentsinclude retrograde or percutaneous instillation ofmitomycin C.

Muscle invasive (T2) and locally advanced(T3-T4) disease Chemotherapy :

MVAC(methotrexate,vinblastine,doxorubicin, cisplatin)

Adjuvant and neoadjuvant chemotherapy

Radiation
http://reference.medscape.com/drug/theracys-tice-bcg-intravesical-live-342204http://reference.medscape.com/drug/trexall-methotrexate-343201http://reference.medscape.com/drug/velban-vinblastine-342096http://reference.medscape.com/drug/platinol-aq-cisplatin-342108http://reference.medscape.com/drug/platinol-aq-cisplatin-342108http://reference.medscape.com/drug/platinol-aq-cisplatin-342108http://reference.medscape.com/drug/platinol-aq-cisplatin-342108http://reference.medscape.com/drug/velban-vinblastine-342096http://reference.medscape.com/drug/trexall-methotrexate-343201http://reference.medscape.com/drug/theracys-tice-bcg-intravesical-live-342204


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Penatalaksanaan

Metastatic and node-positive disease

Chemotherapy

Surgical Therapy

Nephroureterectomy


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KOMPLIKASI

disease progression, obstruction,bleeding, infection, metastasis, and

death


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Kesehatan Masyarakat

(Pencegahan,kesehatanlingkungan,KeselamatanKerja,Gizi-nutrisi)


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Tumor Urotel