Genito-Urinary TumorsGenito Urinary Tumors

Bladder TumorsBladder TumorsCarcinoma of the prostatep

Testicular Tumors

Prof. H.Farsi 0505620033

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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