UR0THELIAL

CARCINOMA OF THE
BLADDER,URETER &
RENAL PELVIS

Dr.dr.. Didit Pramudhito Sp.U

Departemen Bedah RSMH/FK UNSRI
Dr.dr.Didit Pramudhito Sp.U
Dr.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.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.dr.Didit Pramudhito Sp.U

Dr.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.dr.Didit Pramudhito Sp.U

Dr.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.dr.Didit Pramudhito Sp.U

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

Dr.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.dr.Didit Pramudhito Sp.U

Dr.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.dr.Didit Pramudhito Sp.U

Dr.dr.Didit Pramudhito Sp.U
Dr.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.dr.Didit Pramudhito Sp.U

Dr.dr.Didit Pramudhito Sp.U