Renal Pelvis ve Üreter Kanseri
Özet
Metastatik olmayan üst üriner sistem karsinomu (ÜÜSK) nispeten nadir görülen bir durumdur ve tipik olarak böbrek koruyucu cerrahi veya radikal nefroüreterektomi ile tedavi edilir. Seçilen tedavi yöntemine bakılmaksızın, üst üriner sistem karsinomlu hastalar mesanede nüks riski mevcuttur. Böbrek koruyucu cerrahi ile tedavi edilen hastalarda, ipsilateral üst üriner sistemde nüks riski yüksektir ancak kontralateral sistemde, göğüste ve karın/pelviste mevcut bir risk vardır. Yüksek riskli ÜÜSK’i için radikal nefroüretorektomi ile tedavi edilen hastalarda göğüs, karın ve pelvisin yanı sıra kontralateral üst üriner sistemde nüks riski tümör evresine, derecesine ve nodal duruma bağlıdır. Bu nedenle, kanser nüksünün zamanında tespit edilmesini sağlamak için risk tabakalı, bölgeye özel bir takip uygulanması gerekmektedir. Bununla birlikte, takibin türü ve sıklığı/programı hakkında bir konsensus bulunmamaktadır. Görüntüleme ile tespit edilen asemptomatik nükslerin semptomlar nedeniyle tespit edilen nükslerden daha iyi bir sonuç sağlayıp sağlamadığı iyi bilinmemektedir. ÜÜSK’i için kesin tedaviyi takiben gözetim protokollerini destekleyen kanıtlar şu anda seyrektir ve ağırlıklı olarak düşük seviyeli kanıtlara ve uzman görüşüne dayanmaktadır. ÜÜSK nadirliği göz önüne alındığında, büyük prospektif randomize klinik çalışmaların yürütülmesi zor olabilir. Bununla birlikte, kılavuzlar arasında daha yüksek dereceli fikir birliği yaratan kanıtlar elde etmek için daha fazla araştırmalara ihtiyaç duyulmaktadır.
Non-metastatic upper urinary tract carcinoma is a relatively rare condition and is typically treated with kidney-sparing surgery or radical nephroureterectomy. Regardless of the treatment modality chosen, patients with upper urinary tract carcinoma are at risk of recurrence in the bladder. In patients treated with kidney-sparing surgery, the risk of recurrence in the ipsilateral upper urinary tract is high, but there is an existing risk in the contralateral tract, chest and abdomen/pelvis. In patients treated with radical nephrourethorectomy for high-risk upper urinary tract carcinoma, the risk of recurrence in the contralateral upper urinary tract as well as the chest, abdomen and pelvis depends on tumor stage, grade and nodal status. Therefore, a risk-stratified, site-specific follow-up is required to ensure timely detection of cancer recurrence. However, there is no consensus on the type and frequency/schedule of follow-up. It is not well known whether asymptomatic recurrences detected by imaging provide a better outcome than recurrences detected due to symptoms. Evidence supporting surveillance protocols following definitive treatment for upper urinary tract cancer is currently sparse and based predominantly on low-level evidence and expert opinion. Given the rarity of upper urinary tract cancer, large prospective randomized clinical trials may be difficult to conduct. However, further research is needed to obtain evidence of a higher degree of consensus among guidelines.
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