Reinildis Hildegardis Uruk Hane

Relevant Anatomy
Renal pelvis The renal pelvis is the portion of the urinary collecting system formed by the confluence of 2 or 3 major calices. Ureter The ureter is a 20- to 30-cm tubular structure lying on the psoas muscle. It follows an S-shaped curve, passing medially to the sacroiliac joint and then coursing laterally near the ischial spine before passing medially to penetrate the base of the bladder. It passes through a submucosal tunnel to empty into the bladder. Histology The renal pelvis and ureter are lined by a transitional epithelium. The next layer is the lamina propria. External to the lamina propria is smooth muscle arranged in a spiral and longitudinal manner. The outermost adventitia is composed of fibrous connective tissue.

Definisi
Tumor Urothelial Urothelium : lapisan epitel transisional di dinding kandung kemih, ureter, dan pelvis renalis, di sebelah luar lamina propria
Kamus Dorland

FAKTOR RESIKO
Tobacco smoking Drinking coffee slightly increases the risk of upper tract TCC Analgesic abuse Occupational exposure to agents used in the petrochemical, plastic, and tar industries Chronic infections, irritation, and calculi Heredity
http://emedicine.medscape.com/article/452449-overview#a0102

PATOFISIOLOGI
Types of upper urinary tract tumors
Transitional cell carcinoma (TCC) Squamous cell carcinoma Adenocarcinoma Inverted papilloma Tumor suppressor genes P19, P16, RB1, and P53 have all been associated with upper urinary tract TCC. Losses of P53, P19, and P16 are associated with low-grade cancers, while a loss of RB1 has been associated with higher-grade, more aggressive tumors.
http://emedicine.medscape.com/article/452449-overview#a0104

Langkah penegakan diagnosis

Gross or microscopic hematuria (75%) Flank pain (20%) results from gradual obstruction/distention of the collecting system or acute colic due to obstruction by a blood clot. Lumbar mass is noted in 10-20%. Dysuria (6%) is reported; some patients report irritative lower urinary tract symptomatology such as burning upon urination. Weight loss, anorexia, flank mass, or bone pain are symptoms of advanced disease that manifest in a minority of patients.

Langkah penegakan diagnosis

Laboratory Studies
Urinalysis Basic metabolic panel should be ordered to check serum creatinine (assess renal function) and electrolytes. Activated partial thromboplastin time (aPTT), prothrombin time (PT), and international normalized ratio (INR)

Langkah penegakan diagnosis

Intravenous pyelogram (IVP) Cystoscopy to rule out bladder tumor, Urinary cytology CT scan -CT urography.

Langkah penegakan diagnosis

Grading, based on the 2004 World Health Organization (WHO) classification, is as follows: Grade 1 - Papillary urothelial neoplasia of low malignant potential Grade 2 - Low-grade carcinoma Grade 3 - High-grade carcinoma

Langkah penegakan diagnosis

Staging, TNM system (2009),

Tis - Carcinoma in situ Ta - Superficial/papillary, noninvasive T1 - Lamina propria invasion T2 - Muscularis propria invasion T3 Peripelvic fat/periureteral fat/renal parenchyma invasion T4 - Contiguous organ involvement N0 - Negative nodes N1 - Metastasis in single node less than 2 cm in diameter N2 - Metastasis in single node 2-5 cm in diameter or metastasis to multiple nodes less than 5 cm in diameter N3 - Metastasis in lymph node greater than 5 cm in diameter M0 - No distant metastasis M1 - Distant metastasis
The location of the tumor can affect the findings. Renal pelvis tumors are more commonly invasive than bladder tumors, possibly because of delayed diagnosis and a less well-developed muscle layer.

Penatalaksanaan
Superficial (Ta, T1) and carcinoma in situ
Primary : agent bacille Calmette-Gurin (BCG) Adjuvant therapy : Adjuvant topical treatments include retrograde or percutaneous instillation of mitomycin C.

Muscle invasive (T2) and locally advanced (T3-T4) disease

Chemotherapy : MVAC(methotrexate, vinblastine,doxorubicin, cispl atin) Adjuvant and neoadjuvant chemotherapy

Radiation

Penatalaksanaan
Metastatic and node-positive disease
Chemotherapy

Surgical Therapy Nephroureterectomy

KOMPLIKASI
disease progression, obstruction, bleeding, infection, metastasis, and death

Kesehatan Masyarakat (Pencegahan,kesehatan lingkungan,Keselamatan Kerja,Gizi-nutrisi)