Ureothelial

Carcinoma Of
The
Bladder,Ureter &
Renal
Pelvis
Dr. Didit Pramudhito
Sp.U
Departemen Bedah RSMH/FK
UNSRI
dr.Didit Pramudhito Sp.U

dr.Didit Pramudhito Sp.U

Bladder carcinoma
Risk factor:
1. smoking(alpha&betha naphthylamine,
which are secreted into the urine of
smokers.
2. Workers in the chemical,dye, rubber,
petroleum, leather, and printing
industries
3. Cyclophosphamide
4. Artificial sweeteners.
5. Physical trauma to urethelium induced
by infection,instrumentation, and calculi
dr.Didit Pramudhito Sp.U

 Genetic events: activation of

oncogens and inactivation or lossof
tumor supressor genes.
Chromosome 9, 11 p, p21 , 17p, p53

dr.Didit Pramudhito Sp.U

dr.Didit Pramudhito Sp.U

Staging TNM
T 1: lamina propia
T2 a: superficial muscle
T2 b: Deep muscle
T3 a: microscopic invasion of perivesical tissue
T3 b: macroscopic invasion of perivesical tissue.
T4 a: invasion of the prostate,uterus vagiona
T4 b: invasion of the pelvic wall, abdominal wall

dr.Didit Pramudhito Sp.U

dr.Didit Pramudhito Sp.U

 90% transisional cell carcinomas

Symptoms : hematuria, frequency,
urgency and dysuria, bone
pain(metastase)
Sign: no pysical sign, if palpable are
locally extensive(T 3b)
Treatment :
T 1 : TUR + intravesical chemo/
immunotherapy
dr.Didit Pramudhito Sp.U

 T2-4 : Radical
cystectomy+chemotherapy and
irradiation
Any T,N+,M+: Systemic
chemotherapy, surgery or irradiation

dr.Didit Pramudhito Sp.U

Ureteral & Renal Pelvic

Cancer
Carcinoma of the renal pelvis and
ureter are rare (4 % of all urpthelial
cancers.
Ratio Bladder : renal : ureteral = 51 :
3:1
Etiology: smoking and exposure to
certain industrial dyes or solvens
,analgetic
dr.Didit Pramudhito Sp.U

dr.Didit Pramudhito Sp.U

Staging T,N,M
T1 : lamina propria
T2 : invasion of muscularis
T3 : extension through muscularis
into fat or renal parenchyma.
T 4 : spread to adjacent organs
N + : lymph node metastases
M +: metastases
dr.Didit Pramudhito Sp.U

dr.Didit Pramudhito Sp.U

dr.Didit Pramudhito Sp.U

 Synptoms and signs: gross

hematuria,flank pain, flank mass
Imaging: IVU intraluminal filling
defect, nonvisualization of the
collecting system
Treatment: nephroureterectomy

dr.Didit Pramudhito Sp.U

dr.Didit Pramudhito Sp.U