4 강의계획 1. Renal cell carcinoma 2. Urothelial cancer Bladder Renal pelvis Ureter3. Testis, Penis Cancer
5 Cystic renal massesA renal mass that is not clearly a simple cyst by strict ultrasound criteria should be evaluated further with computed tomography (CT).A dedicated (thin-slice) renal CT scan remains the single most important radiographic test for delineating the nature of a renal mass.
12 Clinical Presentation Because of the sequestered location of the kidney within the retroperitoneum, many renal masses remain asymptomatic and nonpalpable until they are advanced.With the more pervasive use of noninvasive imaging for the evaluation of a variety of nonspecific symptom complexes, more than 50% of RCCs are now detected incidentally.
20 요약 초음파에서 단순 낭종 이외의 신종물이 관찰될 때에는 조영증 강 CT를 시행해야 한다. 낭성 신종물에 대한 Bosniak 분류에서 그룹 III 이상은 외과적 적출이 필요한 대상이다.국소 신세포암은 외과적 절제가 최선이며 크기가 작을 경우 콩 팥 전체를 제거하지 않고 암종만 제거해도 된다.전이 신세포암에서 가능한 원발암을 제거하는 것이 추후 전신 치료에 대한 반응을 높혀준다.전이 신세포암은 기존의 고식적인 항암, 방사선 치료에 반응하 지 않고 표적치료가 표준적인 치료이다.
21 Urothelial Cancer: Bladder Endoscopic surgery, BCG instillationRadical surgery
23 Detection of Urothelial Carcinoma Gross, painless hematuria is the primary symptom in 85% of patients with a newly diagnosed bladder tumor, and microscopic hematuria occurs in virtually all patients.The hematuria is usually intermittent; therefore any episode of gross hematuria should be evaluated even if subsequent urinalysis is negative.Fifty percent of patients with gross hematuria will have a demonstrable cause, 20% will have a urologic malignancy, and 12% will have a bladder tumor.
43 Initial presentation Painless testicular mass A firm intratesticular mass should be considered cancer until proven otherwise and should be evaluated further with scrotal ultrasonography.Prior studies show that up to one third of testicular tumors are initially misdiagnosed as epididymitis or hydrocele.
44 DiagnosisIn men presenting with a testicular mass, hydrocele, or unexplained scrotal symptoms or signs, scrotal ultrasonography should be considered an extension of the physical examination because it is widely available, inexpensive, and noninvasive.Testicular cancer is one of the few malignancies associated with accurate serum tumor markers (LDH, AFP, and hCG), a finding that is essential in its diagnosis, prognosis, treatment, and monitoring.Serum tumor marker levels should be obtained at diagnosis, after orchiectomy, to monitor for response to chemotherapy, and to monitor for relapse in patients on surveillance and after completion of therapy.