Renal Cell Carcinoma (RCC)

Paling sering pada orang dewasa, terutama pada laki – laki. Black men > Asians
Dianggap sebagai Silent Cancer karena tanda dan gejala tidak akan terasa/terlihat apabila
belum terlalu besar.

Risk Factors : Smoking, obesity, hypertension.

Etiology
- Occupational Exposures (Asbestos, solvents, cadmium)
- Chromosomal Aberrations
- Tummor suppressor gene
- Cigarrete smoking

RCC terbentuk dari Epithelial Cells yang ada di Proximal Convoluted Tubule (Renal Cortex)
Tipe yang paling banyak dari RCC dibentuk dari Polygonal Epithelial Cells yang isinya
banyak karbohidrat & lipid (yang membuat tumor jadi warna kuning)

RCC mengalami masalah pada Chromosome 3, pada short arm (3p)

Pada chromosome dan semua jaringan, umumnya ada VHL gene  Von Hippel Lindau
sebagai tumor suppressor (pVHL) , bila terjadi mutasi makan akan memicu IGF – 1 untuk
meningkat secara berlebih, menghasilkan :
- Dysregulated cell growth
- Upregulates Hypoxia – inducible factors  upregulates vascular endothelial growth
factor (VEGF) & receptor  New blood vessels / angiogenesis
 Angiogenesis + Dysregulated cell growth = Tumor formation.

Bisa dalam bentuk Sporadic Tumor = Solitary, upper pole of kidney, older men yang
merokok.

Bisa dalam bentuk Inherited Syndrome

- Autosomal Dominant Gene, adanya translocations between short arm Ch3 and long
arm Ch8
- (Von Hippel – Lindau Disease) = Younger men&women, bilateral, rare – autosomal
malignant  mutasi  membentuk cysts dan benign tumors di mata dan CNS.

RCC Clasifies from Histology :

 Clear Cell
 Papillary (Chromophilic)  Less glycogen, less lipids, granular cytoplasm
(Mitchondrian and cytosomes)
 Chromophobe  Large polygonal cells, distinct cell borders,
reticulated cytoplasm
 Collecting Duct  Irregular borders, basophilic cytoplasm, extensive
anaplasia, invade blood vessels, infarction of tissue.
Benign Renal Tumor :
 Papillary Adenoma
 Renal Oncocytoma .  Cytoplasm packed with mitochondria, granular
appearane
 Metanephric Adenoma
Tanda dan Gejala :
Flank pain, Palpable mass in the abdomen or lower
Hematuria
Inflammation (fever, weight loss, anemia, fatigue)

Paraneoplastic Syndromes :
- Peningkatan Erythrocyte karena adanya peningkatan erythropoietin dari efek tumor
dan kompensasi dari adanya hypoxia yang menyebabkan produksi eritropoietin.
- Hypercalcemia karena adanya produksi PTH, osteoclast activating factors
- Hypertension karena produksi renin yang berlebih
- ACTH (Adrenocorticotropic hormones) lead to cushing syndrome karena peningkatan
cortisol.
- Hypoglycemia, Gonadotropins, Galactorrhea

Bila RCC sudah semakin membesar, akan menekan left

renal vein dan menghalangi jalur vena ke left testis.
Menyebabkan dilatasi dari vena testis  Varicocele.
RCC juga bisa menginvasi vena renal, dan inferior vena
cava  high risk metastasis  paru – paru, tulang, lymph
nodes, liver, thyroid, CNS.

Evaluation =
- Plain X – ray
- Intravenous pyelography
- Renal angiography
- CT Scan (Gold standard)
- Staging using Molecular Tumor Markers
- USG

Treatment & Management =

o RCC resisten terhadap chemotherapy & radiation
therapy
o Kalo localized di reseksi aja atau dengan radical
nephrectomy, kalau kecil tumornya bisa partial
nephrectomy
o Sensitive sama immune system, jadi bisa kasih
chemokines & antibiotics, interferon – alpha dan
interleukin – 2
o Molecular Targeted Therapies  inhibit VEGF
receptor
o Tumor obstruction bisa dengan ureteral catheters,
placement nephrostomy tubes

Prognosis :
- T1 – T2 : 5 years survival rate 80-100%
- T3 : 50 -60%
- Metastatic : 16 – 32%
 Bladder Cancer
- Second most common cancer of genitourinary system
- Male: female 2.7:1 - 50-70 yo

Etiology: industrial toxins, cigarette smoking, genetic events, clyclophosphamide, alkylating agents,
radiotheraphy of pelvis

Pathology: transitional carcinoma, squamous carcinoma, adenocarcinoma, other

Grading: 1 (mild anaplasia), 2 (moderate anaplasia), 3 (marked anaplasia)

Symptoms: painless hematuria, irritative voiding symptoms

Lab Test: urine test, urinary cytology, BTA, NMP22, telomerase

Imaging: usg, ivu, mri, ct scan

Cytoscopy

Pakai TNM

Treatment:
 Superficial bladder cancer (Ta, T1, Tis)
Transurethral resection, intravesical chemotheraphy/immunotherapy, cytoscopic surveillance
 Invasive bladder cancer (T2-T4)
Partial/radical cystectomy
 Radiotherapy
 Chemothery

Prostate Cancer
Most common cancer, second cancer that cause death in America

Risk Factor: Age, Genetic (African American), positive family history, high dietary intake, androgen
dependence

Pathology: adenocarcinoma, prostatic intraepithelial neoplasia (high/low grade)

Grading: Gleason system (1- small and uniform gland, 2- more space between glands, 3- infiltration of
cells from glands at margin, 4- irregular masses of cells with few gland, 5- lack of glands, sheet of cells)

Staging:
 Stage I small foci of carcinoma in resection for benign disease
 Stage II disease confined to prostate
 Stage III extracapsular extension
 Stage IV regional lymph node metastases or distant metastases
Symptoms: asymptomatic, metastatic  bone pain, paaresthesias, weakness of lowe extremities
Tests: DRE, Prostate Spesific Antigen, Imaging (TRUS, CT, MRI, Bone Scan), Prostate Biopsy
Treatment: Radical prostatectomy, Radiation, Chemotherapy, Androgen Blockage