肾肿瘤英文版精品医学课件.ppt

Tumors of Genitourinary Tract(泌尿生殖系肿瘤）泌尿生殖系肿瘤）Epidemiology（流行病学）（流行病学） Tumors of genitourinary tract are common disease in adults The rate of morbility are increasing : such as renal carcinoma, prostate cancer and so on the incidence and mortality are increasing the most common disease of male is prostate cancer in USA , and it is increasing conspicuously in China. Your book: bladder cancer is the most one Old: bladder cancer New: prostate cancer is first one.epidemiology （流行病学）（流行病学） Main contents（主要内容）（主要内容）1.Renal carcinoma（肾肿瘤）2.2.Tumor of bladderTumor of bladder（膀胱肿瘤）3.3.prostate cancerprostate cancer（前列腺癌）4.Tumor of the testis（睾丸肿瘤）5.Nephroblastoma（肾母细胞瘤）6.Upper urothelial tumor（上尿路上皮肿瘤）Renal tumor epidemiology（肾肿瘤流行病学）（肾肿瘤流行病学） most of renal tumor are maligant （多数为恶性） most of the renal tumors are RCC（renal cell carcinoma,肾细胞癌） in adults，the rate is about 85% of the maligant ones. nephroblastoma(Wilms tumor) accout about 20% of all maligant disease in children. It is the most common abdominal tumors in children. renal pelvic carcinoma is less Renal tumor cell origin Tumors of renal parenchyma（肾实质） Epithelial tumors of the renal collection system（肾脏集合系统上皮） Renal capsule（肾被膜）, pararenal（肾旁的）/perirenal（肾周的）, mesenchymal(间充质）Pathology of renal cell cancer（病理）（病理） renal tubular epithelial cell (most) renal collecting tubule cell (few)Renal cell carcinoma（RCC，肾细胞癌），肾细胞癌）Renal cell carcinoma（RCC，肾细胞癌）肾细胞癌） 2-2-3% of all adults tumors The morbility is second high of urinary cancers pathology Often one side and most are sigle lesion Most are round and have a pseudocapsule（假包膜） Different size, most of them are 5 to 8 centimeter Cystic degeneration（囊性变性） Calcification（钙化）pathology 12% thrombi（血栓） in renal vein and/or inferior vena（下腔静脉） The thrombi can reach right atrium（右心房）Metastasis lung （肺） renal hilar lymph nodes（肾门淋巴结） ipsilateral adrenal （同侧肾上腺） opposite kidney （对侧肾） bone （骨骼）The path and position of metastasis Path ：invade directly（直接侵犯） lymphatic metastasis: first renal hilar lymph nodes （首先肾门淋巴结侵犯） Common position of metastasis：lung, brain, bone, liver and so on. （通常转移的器官）stageT: 肿瘤病灶N：淋巴结转移情况M：远处转移情况 What may be the symptoms of RCC?肾细胞癌会有什么表现呢？Clinical features（临床特点）（临床特点） More common in the age of 50-70 years old. Morbility: male / female: 2 / 1 30%-50% have no symptoms, most are detected by physical examinationClinical manifestation Painless gross hematuria or microscopic hematuria（血尿）: 60% Triad（三联征）（三联征）: 10% hematuria （表明肿瘤侵入肾盏、肾盂） pain （肿瘤侵犯、血块梗阻） palpable mass（可触及的包块）出现三者之一症状，都提示病变发展到较晚期Accessory tumor syndrome(副瘤综合征） fever （发热） hypertension （高血压） erythrocyte sedimentation rate （血沉增快） hypercalcemia （高血钙） erythrocytosis （红细胞增多症） anemia （贫血） bone pain （骨痛） fracture （骨折） hyperglycaemia （高血糖） marasmus （消瘦） 10% patients to see the doctor because of the symptoms of metastasis, such as: pathologic fracture（病理性骨折） nerve palsy （神经麻痹）hemoptysis （咯血） about 25% appearing metastasis when he first time see the doctorHow to diagnose RCC?(如何诊断肾细胞癌呢？） history and symptoms (病史和症状） physical examination （体格检查） laboratory study （实验室检查） imaging study （影像检查） biopsy (活检）Laboratory findings Hematuria （镜下血尿） Anemia （贫血） Marker (肿瘤标志物）Imaging examination ultrasonography plain abdominal X-rays(KUB) intravenous urography(IVU) isotope scanning（同位素扫描） CT scan MRI (magnetic resonance imaging ) renal angiography（肾血管造影）ultrasonographyLow echo lesionIVUThe renal pelvis was compressedIndrect signartery malformation angiography IVPCT scanCT scanTreatment Radical Nephrectomy (根治性肾切除术）is main methods：may cure the disease Resection area: affected renal （受累肾脏） Perirenal fat （肾周脂肪） Perirenal fascia （肾周筋膜） regional lymph nodes （区域淋巴结） sometimes: adrenal gland and cancer embolus of the vena （有时的同侧肾上腺和静脉癌栓）Treatment Open radical nephrectomy : Laparoscopic radical or partial nephrectomy（腹腔镜全切或部分肾切除术） Side-lying positionLaparoscopic surgeryNephron sparing surgery(NSS) indications: small, solitary renal, bilateral tumor relative indication: benign disease of opposite renal selectable indications: the mass is in the border of renal, or in in the surface of the renal the diameter of the tumor is shorter than 4cmLaproscopic surgeryRadical nephrectomy Nephron sparing surgery (NSS)minimally invasive surgery Radio-frequency ablation 电高温 Cryoablation 冷冻 High-intesity focused ultrasound (HIFU) 聚焦超声热能 for not suitable for resection surgery auxiliary therapy Radiation therapy （放射治疗） chemical therapy （化疗） hormonal therapy （激素治疗） may be little benefit Combined IL(interleukin) - 2 and interferon alfa : about 30% responseFor metastatic RCC New: molecular targeted therapy is more usefulpatients condition prognosis after radical nephrectomy: 5-years survial rates: 70-80% Local nodal invaded: 30% of the 5-years survial distant metastasis:less than 10% of the 5-years survial Other tumors of renal Renal sarcoma （肾肉瘤） Benign renal tumorsangioleiomyolipoma （血管平滑肌脂肪瘤） others