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Subspec GU Tumors
TREATMENT
Bimanual examination RADICAL NEPHRECTOMY
press posterior hand upward – sometime there is transmission of ** Gold standard
impulse to your anterior palpating hand Connotes a malignancy, in contrast to SIMPLE
if able to grasp kidney in the ant. hand and able to mobilize → nephrectomy wherein you dissect different
BALLOTABLE; it means kidneys are not fixed to involve adjacent layers/structure enveloping the kidney and
structures (GOOD prognosis) remove the kidney
If RADICAL, it connote cancer surgery, you DON’T
SIGNS AND SYMPTOMS dissect different layers, you remove the entire
TRIAD – occurs in 7-10% (advanced stage already) kidney with the enveloping structures (perirenal
1. Hematuria (gross / microscopic) – sudden change in the color fascia, pararenal fascia, Gerota’s fascia)
of urine Partial Nephrectomy (nephron- sparing)
Complete type of hematuria wherein from the start up to If mass is in the upper/lower pole
the termination of urine – entire stream is tea-colored For hereditary (bilateral) – you don’t remove all of
If bright red urine – etiology would be from the origin of the kidney
the urinary tract (uretha/bladder neck)
If microscopic, check for Ultrasound and KUB Metastatic disease:
2. Pain (abdominal / flank) – flank pain may be a bleb/blood clot Radical nephrectomy NOT curable anymore
that’s obstructing the ureter Hormonal <15% response rate (progesterone)
3. Palpable abdominal mass – normal kidneys are non-palpable Chemotherapeutic agents
Metastatic disease (LUNGS most common site) RT – NOT sensitive
Dyspnea, cough, bone pain Immunotherapy – investigational (30-40%)
Paraneoplastic syndromes (erythrocytosis, ◦ IFN-A, IL-2
hypercalcemia,HPN,hepatic dysfunction) ◦ VEGF, PDGF inhibitors
Stauffer’s Syndrome (not secondary to metastasis) CYTOREDUCTIVE – diminish tumor bulk/burden;
remove kidney and tumor and give adjunctive
mgmt.
PREMALIGNANT LESIONS
Cutaneous horns
Leukoplakia
Erythroplasia of Queyrat
Condylomaacuminatum
Balanitis xerotica obliterans (BXO)
Buschke – Lowenstein tumor
TREATMENT
Partial penectomy – 2-cm cancer-free margin, pag sa distal
Total penectomy – for extensive lesion,
Creation of a perineal urethrostomy-
Circumcision – small lesion involving the foreskin,curative
management
Inguinal node status – important prognostic factor, poor
prognosis if +
URETHRAL CARCINOMA
Etiology: Unknown
Secondary to old age ,wala na kasing hormones
Women: chronic irritative voiding symptoms / UTI
Men: 25-75%- w/ hx. of stricture disease, Gonococcal strictures
bulbomembranous are(most common site of Ca); 50% have hx.
of venereal disease
END
Black – from power point
Blue – trans from lecturer