비뇨생식기종양
방광암
신장암
전립선암
고환암
난소암
자궁경부암
*암통계: 2009년도 보고서방광암
• 발생율: 3,415명/년(1.7%), 남/녀:2,752/663명, (남자2.7%, 7위)• Epidemiology: smoking
• Treatment
– Superficial:complete endoscopic resection intravesical BCG
– Invasive: cystectomy systemic chemotherapy
– metastatic: chemotherapy
• Curative or palliative
• CR rate: 5-38%, median survival; 9.3-33months
– Chemotherapy
• Adjuvant, neoadjuvant, palliative
신장암
• 발생율: 3,598명/년 (1.8%), 남/녀: 2,520 /1,078명 • 항암화학요법에 반응을 잘 안한다
• 생물학적치료(면역치료 등)에 반응을 한다
– Interferon alpha, interleukin-2
• 자연적으로 치유되기도 한다 • 최신치료법으로 표적치료제가 많이 개발되었고, 현재 표준치료로 되어 있음
신장암의 병기와 예후
병기 내용 5년 생존율 1기 Confined to kidney >90%2기 Invade renal capsule, confined to Gerota fascia
85% 3기 Involve renal vein/vena cava,
hilar lymph node
60%
4기 Invade adjacent organs or
distant metastasis
신장암의 치료
• Localized tumor: stage I, II and selected III
– radical nephrectomy
• Advanced disease
– Cytotoxic chemotherapy: rare response – Immunotherapy
• Interferon alpha & IL-2: 10-20% response
– Surgery
• Control pain, bleeding
• Metastatectomy: solitary or CNS
• Cytoreductive surgery before systemic tx in selected cases
– New agents
• Tyrosine kinase inhibitors, VEGF inhibitor(multi-targeted)
– Sunitinib, Sorafenib(40% response rate)
• mTOR inhibitor: Temsirolimus, Everolimus
– Poor prognosis, sunitinib/sorafenib refractory
Molecular Pathways & Targeted Therapies in RCC
Sunitinib vs Interferon alfa in metastatic renal cell carcinoma
N engl J Med 2007;356:115-124
Sorafenib in advanced clear cell renal cell carcinoma
N Engl J Med 2007;356:125-134
CR PR SD Sorafenib, N=451 1(<1%) 43(10%) 333(74%) Placebo, N=452 0 8(2%) 239(53%)
전립선암
• 발생율: 7,848명/년(3.9%)
– 한국남자암발생 5위 (7.6%)
Treatment:
Clinically localized disease
• Treatment modalities
– Radical prostatectomy – Radiation therapy
• External beam RT, Brachytherapy
– Active surveillance
• Monitoring illness at fixed interval with no treatment • Case selection is critical
• Consideration factor for choice of therapy
– Presence of symptoms
– Probability that untreated tumor will adversely affect quality or duration of survival.
– Curability by single-modality therapy or both local & systemic therapy
• Primary outcomes
– Cancer control & treatment related morbidities
• Continence, sexual potency, bowel function • Prognostic model
– Initial T stage, Gleason score, baseline PSA
Treatment:
Rising PSA
• Definition:
– Rising PSA after surgery and/or radiation – No evidence of disease on scan
• Central issue
– Persistent disease in primary site or systemic disease
• Localized disease
– Radiation, Salvage prostatectomy
• Systemic disease
– Immediate therapy is not always required
• Median time to metastatic progression: 8 yrs • Free of metastases at 5 yrs: 63%
– Prognostic factors:
Treatment:
Metastatic disease
• Noncastrate
– Deplete/lower androgens
• Surgical orchiectomy • Medical orchiectomy
– Testosterone lowering agents
» GnRH agonist/antagonist: » leuprolide, goserelin/degarelix » Estrogen(diethylstilbestrol)
– Antiandrogen
» Flutamide, bicalutamide, nilutamide
• Castrate
(Castration-resistant; CRPC)– Castration testosteron level:< 50ng/ml – Discontinue all hormonal therapy:
• withdrawal response
– 2nd-3rd line hormone therapy
– Chemotherapy: docetaxel, mitoxantrone
고환암
• Origin: primordial germ cells
• Extragonadal
– Mediastinum, retroperitoneum, pineal gland
• Disease of young age
– 호발연령: 20-40세
• 백인>흑인
• 호발지역: Scandinavia, New Zealand
• 발생율: 206명/년(한국남성암의 0.1%)
Etiology & Genetics
• Cryptorchidism
• Testicular feminization syndrome
• Klinefelter’s syndrome
– Mediastinal tumor
• Incidence of another testis: 2%
• Chromosome 12
– Excess copy number, i(12p)
• Tumor marker
– AFP: nonseminoma – hCG: seminoma, nonseminoma – LDHTreatment (1)
• Stage I, nonseminoma – Orchiectomy – Nerve sparing RPLND• vascular/lymphatic invasion or extends into tunica,
spermatic cord, scrotum(T2-4)
– Surveillance
• No vascular/lymphatic invasion(T1) – Cure rate: > 95%
• Stage II, nonseminoma
– Modified bilateral RPLND
– High-volume(> 6 nodes, > 2cm node) • 2 cycles of adjuvant chemotherapy – Cure rate: > 98%
• Stage I & II seminoma
– Inguinal orchiectomy & retroperitoneal radiation – Cure rate: 98%
Treatment (2)
• Advanced GCT
– Stage IIc & stage III
– Chemotherapy: cisplatin, etoposide, bleomycin – Cure rate: 70-80%
– Risk-directed chemotherapy
• Salvage chemotherapy
– 2nd line chemotherapy
• Cure rate: 25%
– High dose chemotherapy & stem cell support
• Post-treatment complication
– Infertility, ejaculatory dysfunction
Incidence, Epidemiology, Etiology
• Pathologic classification
– Epithelial, stromal, germ cell tumor
• 발생율: 1,981명/년(여성암 2.0%, 10위)
• Peak age: eighth decade
• Risk factors
– Infertility, nulliparity, frequent miscarriages, use of
ovulation-inducing drugs(clomiphene)
– Reducing factor: pregnancy, breast feeding, oral
contraceptive
• Familial syndrome
– Hereditary breast/ovarian cancer
• BRCA1&2 mutation
– Lynch type II cancer family syndrome
Diagnosis, Screening, Pathology
• Routine pelvic examination
• CA125
– Postmenopausal women, asymptomatic pelvic mass,
CA125 65U/ml
• Screening
– Annual pelvic examination, transvaginal ultrasound,
CA125 in family history of ovarian cancer
• Subtype of common epithelial tumors
– Serous(50%), mucinous(25%), endometroid(15%), clear
cell(5%), Brenner tumors(1%)
Staging, Prognostic factors
• Staging laparotomy
– Manual inspection of diaphragm, peritoneal surfaces,
total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy
• 5-year survival
– Stage I(90-95%), II(70-80%), III(20-50%), IV(1-5%)
• Prognostic factors
– Residual disease, histologic grade, decline of CA125 – Expression of p53, EGFR
Treatment (1)
• Stage I&II, microscopic or no residual disease
– Stage I, no residuals, well/moderately differentiated:• no adjuvant therapy
– Stage I with poor histologic grade, stage II:
• adjuvant therapy (cisplatin based chemotherapy or
total-abdominal irradiation)
• Stage III, minimal residual tumor (<1cm)
– Combination chemotherapy (cisplatin, paclitaxel) – CR: 40-50%• Advanced disease(Stage III, IV), bulky residual
tumor
– Combination chemotherapy followed by cytoreductive
surgery
Treatment (2)
• Recurred disease
– Not curable – Palliative surgery– Disease-free interval: > 6 months
• Reinduction with same regimen
• Intraperitoneal chemotherapy
– Small residual volume (<1 cm3)• New drugs
– topotecan, gemcitabine, liposomal doxorubicin, – bevacizumab
자궁경부암
• 발생율: 3857명/년 (여성암 3.9%, 7위)
2010년 암발생율
Treatment
• Stage 0 (carcinoma in situ)
– Cone biopsy, abdominal hysterectomy
• Stage IA
– Total or vaginal hysterectomy
• Stage IB-IIA
– Radical hysterectomy, Radiation therapy
• Stage IIB – IVA
– Radical radiation
– Concurrent chemoradiotherapy
• Platinum based chemotherapy • 30-50% risk reduction
• Unresectable advanced/Recurrent
– Palliative chemothx: cisplatin, 5-FU, irinotecan – Response of combination chemotherapy: 50-60%
