Basic Principles in Urological Oncology PDF

BASIC PRINCIPLES OF UROLOGIC ONCOLOGY UĞUR BOYLU, M.D. Professor of Urology Istinye University, Faculty of Medicine, Department of Urology Liv Hospital Ulus, Istanbul  Basic Concepts and Techniques in Cancer Biology Cancer as a result of g...

BASIC PRINCIPLES OF UROLOGIC ONCOLOGY UĞUR BOYLU, M.D. Professor of Urology Istinye University, Faculty of Medicine, Department of Urology Liv Hospital Ulus, Istanbul  Basic Concepts and Techniques in Cancer Biology Cancer as a result of genetic and epigenetic changes in somatic cells First step, non-fatal genetic damage to the cell CARCINOGENESIS CANCER IS A GENETIC DISEASE? DNA STRUCTURE GENETIC DATA TRANSITION HUMAN GENOME  Mutation and Epigenetics Oncogene Tumor suppressor gene Carcinogenesis models Multistep, Aneuploidy, Stem cell Cell cycle G1-S-G2-M Cell death - Apoptosis Cell cycle stages  Proto-oncogene: found in normal cells and responsible for normal cellular events Oncogene: Modified versions of proto-oncogenes Responsible for uncontrolled cell proliferation (Ras, Myc, Bcl-2, erb-B, cyclin-D) Tumor Suppressor Genes: They prevent tumor formation (P53, Retinoblastoma (Rbl), Wilms' Tumor (WT-1) gene, Von Hippel Lindau (VHL), NM-23)  Homeostaz The equilibrium state of an organism or cell Cancer Cell division Cell differentiation Cell death Correct functional answer  Screening The aim of screening is to detect patients with no clinical symptoms at an early stage and to provide treatment and prolong survival The group to be screened should be selected from the group with the highest probability of occurrence. For example: prostate cancer occurs in advanced age, testicle at a young age  Screning The test to be used for screening should have a high sensitivity, and if possible, its specificity. For example: PSA used in prostate cancer screening has high sensitivity (75-80%) but low specificity (25%) Screening in Uro-Oncology  Prostate Cancer n Prostate hard on digital examination n Urination complaints n Findings of the spread of the disease n Bone pain, fractures, weakness n Weight loss n Blood in the semen n No complaints (PSA height)  Those affecting PSA v Benign prostate enlargement v Prostate cancer v Prostate inflammation v Inability to urinate v Probe insertion v Performing an endoscopy v Sexual ejaculation? v Digital examination? v 5 ARI (Avodart, Proscar (-))  Prostate Cancer European Association of Urology recommends screening at application, not community screening If there is no risk factor in the family, screening starts at the age of 50 in the Caucasian race, and at the age of 45 if there is a family history PSA level is checked in screening and a digital rectal examination is performed If there is any doubt about either of them, a prostate biopsy is performed Otherwise, if the PSA is below 1, screening is continued after 8 years, if it is between 1-2.5 every two years  Does Life Time Increase with Prostate Cancer Screening? The incidence of prostate cancer detection increases as a result of screening More localized cancer (T1, T2), less advanced stage PCa (T3-4, N1, M1) In 5 separate RCTs (randomized controlled studies), 341 thousand patients were diagnosed with PCa, so no data on the increase in life expectancy was detected ??? 'No overall survival benefit' in 4 RCT studies Over-diagnosis and over-treatment However, since the diagnosis was made, no patient died All these data are against systematic screening in the world  Prostate Cancer Risk PSA> 1 ng / mL at 40 years and> 2 ng / mL at 60 years of age increased risk of metastasis and death from PCa Suggest screening for men> 50 years of age and> 45 years of age with a family history of Pca African-Americans> 45 years EAU Guideline  Prostate Cancer Screening American Cancer Society (ACS), annual PSA testing and DRE from the age of 50 in men with a life expectancy of at least 10 years Screening is recommended for the high risk group at an earlier age (40-45) African-American men Has a history of PCa in one or more 1st degree relatives The benefits and potential risks of screening?  Bladder Cancer Hematuria Urinary symptoms ?? Suprapubic pain Lumbar pain (DM, Elderly, Neuropathic)  Bladder Cancer There is no community screening Bladder cancer screening is not performed when applying for another reason There is no specific or sensitive blood or urine test At least ultrasonography is essential for diagnosis, which increases the cost too much ??  Testicular Cancer Pain Mass Hematospermia, hematuria Low back pain, abdominal pain Gynecomastia  Testicular Cancer Tumor markers are specific but not sensitive. Medical examination and / or ultrasonography are required for diagnosis. The incidence is also low Even in advanced stages, cure is provided with chemotherapy. For these reasons, scanning is not recommended. Young men should learn self-examination  Kidney Cancer There is no tumor marker. Today, approximately 70% of them are diagnosed incidentally. Only 10% of patients have specific symptoms (flank pain, hematuria or palpable mass) Routine screening not recommended Periodic screening is recommended in risk groups (such as familial VHL)  Hematuria Having erythrocytes in the urine is called hematuria. Visibly macroscopic If there is too much blood in the urine, gross or abundant hematuria Microscopic hematuria is defined as having more than 5 erythrocytes in women and more than 3 in men in 100 magnification area  Causes of Hematuria- Urology Kidney stone Tumor Trauma Tuberculosis  Causes of Hematuria - Non-Urological Exercise Nephrological (Glomerulonephritis, nephrotic syndrome) Coagulopathy  Microscopic Hematuria Hematuria of unknown cause is called persistent hematuria in microscopy, which is examined twice in one month 3-5% persistent hematuria in the community may be without cause Causes: stone, infection, tumor, nephrological causes Tumor frequency is around 1-2% Routine urine culture, blood tests and ultrasonography should be done. Cystoscopy may be recommended to those over the age of 50 and / or smokers for at least 10 pack years  Macroscopic Hematuria Bladder cancer is the most common cause in people over the age of 50 90% of urothelial cancer is detected if it is painless and clotted more than once in more than one day. Even if the ultrasound is natural, cystoscopy should be done if it occurs at least twice The second most common cause is the prostate (benign growth or local invasive cancer) Therefore, PSA should be checked, a digital examination should be performed and a prostate ultrasound should be performed It should be kept in mind that kidney tumor (especially pelvis ureothelial cancer) may rarely cause Principles in Uro-Oncological Surgery  Basic Principles Surgery is performed in all uroncological tumors as much as possible in the first step It is impossible to cure with chemotherapy or RT in metastatic tumors except testis, only survival can be prolonged  Local Stage Tumors The primary treatment is surgery in all localized tumors, but it should not be forgotten that RT is head-to-head with surgery in prostate cancer Treatment alternatives should be explained to patients Side effects of the treatments, how they are applied and additional treatments that may be required in the future Pathology result Will the patient's compliance with the surgery be sufficient?  Local Invasive Tumors T3 and T4 tumors are considered locally invasive T3 tumors are at the margin of surgery Surgery is performed if T4 can be performed in prostate and bladder cancer, but most of the time it is not possible In kidney tumors, efforts should be made to perform surgery even if T4 is present  Metastatic Testiculer Tumors Metastasis in testicular cancer is not contraindicated to surgery, orchiectomy is performed, the patient is then directed to chemotherapy In the presence of widespread metastasis (especially lung), if the patient is unable to wait for orchiectomy and the next recovery period, chemotherapy is given quickly  Metastatic Prostate Tumors Until recent years, metastasis was considered a contraindication for surgery in prostate cancer However, in the absence of oligometastatic (