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- 1.renal cortex
- 2. fibrous capsule
- 3. minor calyces
- 4. blood vessels entering renal perenchyma
- 5. renal sinus
- 6. major calyces
- 7. renal pelvis
- 8. fat in renal sinus
- 9. minor calyces
- 10. ureter
- 11. base of renal pyramid
- 12. medullary rays
- 13. renal column(of Bertin)
- 14. renal papilla
- 15. renal medulla(renal pyramid)
- 1.median umbilical ligament
- 2. transitional epithelium
- 3. lamina propria
- 4. submucosa(2&3)
- 5. detrusor muscle
- 7. external urethral sphincter
- 8.internal urethral sphincter
- 9. neck of urinary bladder
- 10. trigone
- 11.ureteral opening
- 12.detrusor muscle
- 13. peritoneum
- 14. ureter
What are the parts of the urinary system and what are their functions?
- 1)Kidneys(primary organ or urinary system)
- lie on either side of body at level T12-L3
- left kidney slightly higher(liver on right)
- function: 1)excretion of bodily wastes such as water, urea, and uric acid 2)disposal of excess water and salts 3)regulation of ph of blood and body fluids
- 2)Ureters-transposts urine away from the kidneys
- 3)Urinary Bladder- stores urine
- 4)Urethra-a tube that transports urine from the bladder to outside the body
What are the primary organs of the urinary system?
What are the three functions of the kidneys?
- 1)excretion of bodily wastes such as water, urea and uric acid
- 2)disposal of excess water and salts
- 3)regulation of ph of blood and body fluids
Where do the kidneys lie anatomically?
The kidneys lie on either side of the vertebral body at about the level of T12-L3. The kidneys are positioned retroperitoneally, which means behind the parietal peritoneum and against the deep muscles of the back. The right kidney is lower because of the liver.
Bladder Cancer peaks at age ___.
Bladder cancer affects (men/women?) ______times more than (men/women?).
men ,4, women
Important prognostic factors for bladder cancer are:
- 1)Tumor extent and depth of muscle invasion
- 2)Tumor morphology: papillary tumors are usually low grade and superficial.
- Infiltrating lesions tend to be high grade, sessile(fixed), and nodular
The areas of the bladder that cancer is likely to occur are:
- 2)posterior/ lateral walls
- 3) neck of the bladder
The most common tumor of urinary tract:
Etiology of bladder cancer includes:
- 1)Dye, rubber, textile, leather, pain working
- 2)Chronic bladder infections
- 4)Previous pelvic irradiation
- 5)Pesticide exposure
- 6)Contaminated water supply
Clinical presentation of bladder cancer:
- 1)Gross painless hematuria(Blood in the urine that can be seen with the naked eye)-THIS IS HOW MY DAD'S WAS DISCOVERED-TINY LITTLE RED DOTS IN HIS URINE
- 2)Urinary tract infection
- 3)Clotting and urinary retention may occur
- 4)Frequency, urgency, dysuria, and hematuria
Detection and diagnoses of bladder cancer is done with:
- 1)History and physical
- 2)Transurethral biopsy of the bladder (TURB)
- 3)Chest xray
- 5)Complete blood work
- 6)Liver function test
- 7)Cystoscopic evaluation
Most bladder cancers are epithelial(98%): 92% of which are ____________. 7% are_________.
2% are ____________.
- transitional cell
- squamous cell(Patients who have had chronic irritation from catheters)
Bladder cancer morphologies include:
- 1)Papillary(finger-like projections) -most common LEAST AGGRESSIVE
- 2)Papillary infiltrating(agressive)
- 3)Solid infiltrating(agressive)
- 4)Nonpapillary or carcinoma in situ (agressive)-
- *UNIQUELY IN BLADDER CANCER, CARCINOMA IN SITU (cis) IS AN ADVERSE PROGNOSTIC FEATURE
*Most bladder cancers are a type of malignancy called ___________, and are discovered in the early stages of the disease when it is superficial and has not penetrated deeply into the wall of the bladder. This form of bladder cancer has a limited capacity to spread
through the bladder wall to other organs, and is highly treatable but often recurs locally within the bladder.
transitional cell carcinoma
Where does bladder cancer spread to?
Lymphatic drainage for the bladder:
- External iliacs
- Internal iliacs
- presacral nodes
Staging of bladder cancer if done by:
the depth of invasion into the bladder wall
Low grade bladder tumors are:
High grade bladder tumors are:
Bladder cancer spread is through:
- direct extension
- perineural(Near a nerve or nerves)
- blood vessels
When bladder cancer spreads by direct extension it spreads
___________% of bladder cancers are superficial at diagnosis.
After the bladder cancer has invaded the muscle, it spreads through:
- blood vessels
Treatment for bladder ca staged at Ta and T1:
- Transurethral resection and fulguration or radical
- cystectomy. Intravesical immunotherapy
- chemotherapy is added
Treatment for carcinoma in situ(cis) is________, but
for lesions that don’t involve bladder neck, prostatic urethra, or ureters treatment consists of_________.
- Surgery(radical cystectomy)
- electrofulguration followed by intravesicle chemotherapy orbacillus Calmette-Guerin (bCG)
Bladder cancer Tis,Ta, T1 failures are treatment with:
radical cystectomy for salvage
Bladder cancer T2,T3, and T4a can treated with:
- *ALSO Tis, Ta, T1 failures are treatment with radical
- cystectomy for salvage
For bladder cancer,radiation therapy can be used____and save surgery for ____.
For bladder cancer, chemotherapy:_______________________.
tumor. Drugs include:______________________________
- is used with RT to sensitize the local
- methotrexate, cisplatin, and vinblastine
RT portals for bladder cancer
entire bladder and tumor volume, prostate and prostatic urethra,and pelvic lymph nodes
Radiation therapy 4 field box borders for bladder cancer are:
- Top border – L5/Si
- Bottom border – 1 cm
- below obturator foramen
- Width – 1.5 cm beyond
- bony pelvis
- Anterior – encompass
- the entire bladder
- Posterior – encompass
- the entire bladder
Radiation therapy dose for bladder cancer is:
- Large pelvic field 45-50Gy Boost fields15-20Gy
- (Total: 60-70 Gy)
Position for RT for bladder cancer:
- 1)Supine with hands folded on abdomen
- 2)Bladder volume should be consistent so instruct patient to empty bladder before treatment-treat bladder cancer when the bladder is empty but boost it when it is full
- 3)Immobilization for the lower extremities with alpha cradle, vac lock, simple block, and velcro feet
Side effects of radiation therapy for bladder cancer include:
- 4)Decreased blood counts
5 year survival for superficial disease is_____. Disease invading the muscle is ____.
Renal Cell Carcinoma peak age is ____
with male-to-female ratio ____.
Etiology for renal cell carcinoma:
- 1)Environmental, occupational, hormonal, cellular, andgenetic factors
- 4)Cigarette and tobacco use
- 6)Analgesic abuse
- 8)Von hippel-Lindau disease(rare, genetic disease that causes tumors and cysts to grow in your body)
Etiology for Renal Pelvic and Ureteral Carcinoma:
- 1)Urban residency
- 2)Cigarette and tobacco use
- 3)Aminophenol exposure
- 4)Renal stones
Renal Pelvic and Ureteral Carcinoma: what is the men to womwn ratio?
Men versus women in 3:1
Peak incidence for Renal Pelvic and Ureteral Carcinoma is___________.
50-60 years of age
Prognostic Indicators for renal cell cancer:
- 1)Stage and histologic grade
- 2)Lymph node involvement
*same as Renal Pelvic and Ureteral Carcinoma:
Prognostic Indicators for Renal Pelvic and Ureteral Carcinoma:
- 1)Stage and histologic grade
- 2)Lymph node involvement
*Same as renal cell cancer
Lymphatic drainage from kidneys:
- Paraaortic(1-4) and paracaval(5-7) nodes
- BASICALLY, LYMPHATIC DRAINAGES FOR THE KIDNEYS ARE THE NODES THAT:SURROUND THE AORTA & VENA CAVA
- Left Lumbar Lymph Nodes (Paraaortic Lymph Nodes)
- 1. Lateral aortic
- 2. Preaortic
- 3. Postaortic
- 4. Intermediate Lumbar
- *Para aortic means surrounding the aorta
- Rt Lumbar Lymph Nodes (Paracaval Lymph Nodes)
- 5. Lateral caval
- 6. Precaval
- 7. Postcaval
- *Para Caval means surrounding the vena cava
Lymphatic drainage from ureters:
- Paraaortic, paracaval- (same as kidney) & common iliac,internal iliac, and external iliac nodes-
- (all the iliacs)
- *Lymphatic drainage from ureters is the same as the kidneys-PARAAORTIC, PARACAVAL, & ALL OF THE ILIACS
- 1)para aortic lymph nodes
- 2)right common iliac lymph nodes
- 3)right common iliac lymph nodes
- 4)right external iliac lymph nodes
- 5)right internal iliac lymph nodes
- 6)left external iliac lymph nodes
- 7)left internal lymph nodes
Clinical presentation of renal cell cancer:
- 1)Occult primary tumor
- 2)Gross hematuria
- 3)Abdominal mass
- 5)Weight loss
Clinical presentation of Renal pelvic and ureteral carcinoma:
- 1)Gross or microscopic hematuria
- 3)Bladder irritation
Detection and diagnoses of renal cell, renal pelic and ureteral cancers:
- 1)History and physical
- 5)Bone scan
- 7)Blood chemistry
- 8)Urine cytology
The tissue of origin for renal cell carcinoma is ______ The most common type of renal cell carcinoma is ____________.
- Clear cell carcinoma
Pathology of Renal Pelvis and Ureteral cancer is:
- 1)Transitional cell 90%
- 2)Squamous cell 7%
Staging of renal and ureretal cancers
(TNM) is based on:
extent through the layers of the kidney or pelvis
5 year survival for renal cancers:
- 5 year survival:
- Stage 1-88%
- Stage II-67%,
- Stage IV-2%
Renal cell routes of spread:
- 1)Local infiltration through the renal capsule
- 2)Direct extension in the venous channels
- 3)Retrograde venous drainage to the testis
- 3)Lymphatic drainage to the renal hilar, paraaortic, and paracaval nodes
- 4)Hematogenous route to lung, liver, CNS, and bone
Renal Pelvis and Ureteral Carcinoma routes of spread:
- 2)Direct extension, blood, and lymphatics
Treatment Techniques for renal cell cancer:
- 1)T1 and T2 – radical nephrectomy
- 2)Definitive radiotherapy is limited due to low tolerance doses in the upper abdomen. Usually considered palliative
- 4)Immunotherapy – interferon and interleukin
Treatment Techniques for Renal Pelvis and Ureteral Carcinoma:
- 1)Nephroureterectomy with the excision of a cuff of bladder and bladder mucosa
- 2)Chemotherapy- methotrexate, vinblastine, doxorubicin,and cisplatin
Radiation therapy for renal cell carcinoma:
- 1)Post-Op or for recurrence following surgery
- 2)Treatment volume includes renal fossa, and paraaortics
- 3)Doses 4500-5500 cGy
- 4)IMRT, AP/PA, or wedge pair.Spare as much bowel
- as possible
Radiation therapy for Renal Pelvis and Ureteral Carcinoma:
- 2)Treatment volume involves renal fossa, ureteral bed and ipsilateral bladder trigone
- 3)Doses 5040 with 540 boost
Side effects to RT for renal cancers:
- 1)N and V
- 3)Abdominal cramping
- 4)Bowel obstruction
*NOTICE-ALL SMALL BOWEL TOXICITIES FROM SMALL BOWEL DISPLACING INTO VOID LEFT BY KIDNEY
Describe the classic triad of kidney cancer and state what stage they are associated.
- The classic triad is hematuria
- (blood in the urine), flank pain and an abdominal mass.
- This triad only occurs in 10-15% of cases, and is generally indicative of more advanced
- Today, the majority of renal tumors are asymptomatic and are detected incidentally on imaging, usually for an unrelated cause.
What is the most common type of kidney
Renal Cell Carcinoma
(RCC) is the most common type of kidney cancer, accounting for approximately 85% of all malignant kidney tumors.
- In RCC, cancerous (malignant) cells develop in the lining of the kidney tubules
State the frequency of adult kidney tumors and state which age they most often occur?
Overall, the lifetime risk for developing kidney cancer is about 1 in 63 (1.6%)
- Renal cell carcinoma-Peak Age is 55-60 with male-to-female ratio 2:1
- Renal Pelvic and Ureteral Carcinoma -Peak age 50-60 years of agemale-to-female ratio 3:1
What are the possible etiologic agents for kidney tumors?
- Cigarette and tobacco use
- Analgesic abuse
- Von hippel-Lindau disease
- Urban residency
- Aminophenol exposure
- Renal stones
Where do most kidney tumors arise?
The proximal tubular epithelium is the tissue of origin for renal cell carcinoma. Clear cell carcinoma is the predominant subtype
What is the percentage of tumors arising
in the renal pelvis? State the most common type of tumor found here.
- About 7% of renal neoplasms are
- transitional cell carcinoma(which are renal pelvis cancers)
What is the most common presenting symptom of kidney cancer?
Whay is the treatment of choice for renal cell cancer?
Once the disease has metastasized, obviously surgery is not effective(T3 and up)
What is the role of XRT in the treatment
of kidney cancers?
Post op or for reccurance following surgery
What is the max dose that can be given
to both kidneys without causing acute radiation nephritis?
Discuss where the filtration of the blood for the production of urine occurs.
State where reabsorption of useful substance in the filtrate occurs.
in the renal tubules and collecting ducts
Discuss how urine volume is regulated.
- Urine volume is regulated primarily by ADH.
- When blood volume decreases, the concentration of salts increases; this change is sensed by the hypothalamus, which in turn stimulates the posterior lobe of the pituitary to release ADH. ADH travels to the collecting ducts where the ADH makes the walls permeable to water. Consequently, more water is reabsorbed into the bloodstream instead of being excreted, and urine
- volume decreases.
Track the flow of urine from the glomerulus to outside the body.
- 2)Bowman's Capsule
- 3)Proximal convoluted tubule
- 4)Loop of Henle
- 5)Distal convoluted tubule
- 6)Collecting duct
- 7)Minor calycx
- 8)Major calycx
- 9)Renal pelvis
Describe the inner most layer of the bladder.
- It is Transitional epithelium (also known as ca found in the urinary tract, especially around the urinary bladder
- The most common kind(92%) of bladder cancer is transitional cell carcinoma which starts in the transitional epithelium.
Describe the anatomic location of the bladder.
It is located in the pelvic cavity behind the pubic symphysis, in the male it lies against the rectum posteriorly, in the female it contacts the anterior walls of the uterus and the vagina.
Discuss diagnostic procedures used to detect
- History and physical
- Bone scan(bone mets)
- Blood chemistry
- Urine cytology
Discuss the patterns of spread for kidney tumors.
- Renal Cell
- •Local infiltration through the renal capsule
- •Direct extension in the venous channels
- •Retrograde venous drainage to the testis
- •Lymphatic drainage to the renal hilar, paraaortic, and paracaval nodes
- •Hematogenous route to lung, liver, CNS, and bone
- Renal Pelvis and Ureteral Carcinoma
- •Direct extension, blood, and lymphatics
- 2)renal cortex
- 4)fat pad
- 5)renal rcapsule
- 7)renal pelvis
- 8)renal vein
- 9)renal artery
What is a transurethral resection(TUR) and when is it used?
- Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose
- bladder cancer and to remove cancerous tissue from the
- bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor).
- General anesthesia or spinal anesthesia is usually
- used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells.