RENAL (KIDNEY) PELVIS AND URETER TUMORS
It constitutes 5-10% of renal tumors. It is more common in men; It is more common in people aged 65 and above and may be bilateral in 2-4%.
Ureter Cancers
ETIOLOGY (CAUSE)Although the exact cause is not clear;
Smoking - long-term use of some painkillers such as phenacetin - long-term use of a drug used in chemotherapy called cyclophosphamide - chronic urinary tract infection - stones left untreated for a long time - stones in the urinary tract Diseases that cause obstruction - Balkan nephropathy is among those responsible.
PATHALOGY
90% of them involve the inside of the urinary tract, as in bladder tumors. (TCC: transitional epithelial cell carcinoma) Squamous (squamous epithelial) cell cancer is encountered at a rate of (Ca)10% and the cause is usually are stones. Less than 1% may also be adenoca, and these are also associated with stones and infection.
At the time of diagnosis, 30% of renal pelvis tumors are high grade and 65% are located in the renal pelvis.
70% of ureter tumors are detected in the distal (lower part)ureter. Tm in the upper urinary system of patients with bladder tm. risk of developing: 2 – 4%;
Bladder tumor of patients with renal pelvis and ureter tumor. The risk of development: 30 - 75%.
Metastases are most common in: Lymph nodes - Lung - Liver and Bones.
Stage and grade are the most important criteria in determining prognosis. Multifocality (detection in more than one focus) is usually seen in high grade patients and indicates poor prognosis.
CLINIC AND DIAGNOSIS
80% PAINLESS MACROSCOPIC (visible to the eye)HEMATURIA (bleeding in the urine)Abdominal pain - weight loss - Nausea / Vomiting - Not specific to the type of cancer such as anemia (Nonspecific) findings may also be encountered.
DIAGNOSIS
All painless hematuria should be approached with the concern that there is an underlying tumor until the contrary is proven.
Ultrasound First. nography (US) and/or Urography (IVP)should be performed. US: It may show a mass in the renal pelvis or images of upper enlargement may be obtained due to a mass in the ureter. IVP: Filling defect and lack of function in the kidney (nonfunction) can show it.
COMPUTED TOMOGRAPHY (CT)
It is an examination method that should be preferred because it can show the mass in both the renal pelvis and ureter, as well as metastases in the surrounding tissues.
p>
URETEROSCOPY
is an examination that can be performed to see the inside of the ureter more clearly in cases of bleeding whose cause cannot be determined by other examinations.
Additionally: Retrograde pyelography - cytology and cystoscopy can also be performed. p>
STAGAGING
- To : No Tm
- Tx : Primary tm cannot be determined
- Tis : Carcinoma insitu
- T1 : Papillary non-invasive carcinoma
- T2: Involvement of the muscle
- T3: Involvement of peripelvic or periureteral soft tissue or renal parenchyma
- T4: Involvement of adjacent organs : Regional lymph nodes
- No: No significant lymph node was detected by clinical evaluation.
- N1: Metastasis in the lymph node smaller than 2 cm. There is.
- N2: There is a 2 - 5 cm metastasis (met.) in the lymph node or there is metastasis (met.) in more than one lymph node smaller than 5 cm. There is
- N3: Mett greater than 5 cm in the lymph node. varM: Distant metastasis
- Mo: Distant metastasis. none
- M1 : Remote met. var
TREATMENT
Nephroureterectomy (removing the area where the ureter enters from the kidney + ureter + bladder) is the ideal treatment. This procedure can be performed laparoscopically as well as open surgery.
Conservative (organ preserving) approaches in low grade and stage TMs (Endoscopic resection - tum. excision and end to end anastomosis to the ureter). or neocystostomy)may be tried.
Chemotherapy and/or Radiotherapy may be tried in metastatic cases.
Read: 0
