Üretral Tümörlere Yaklaşım
Özet
Primer üretral tümörler, tüm genitoüriner sistem malignitelerinin %1'inden azını oluşturan oldukça nadir görülen kanserlerdir ve insidansı 75 yaş üzerinde pik yapmaktadır. Hastalık erkeklerde üretral darlık ve kronik inflamasyonla; kadınlarda ise üretral divertikül ve enfeksiyonlarla ilişkilendirilmektedir. Histopatolojik olarak en sık ürotelyal karsinom, skuamöz hücreli karsinom ve adenokarsinom formlarında gözlenir. Çoğu hasta lokal ileri evrede başvururken, hematüri ve üretral kanama en yaygın semptomlardır. Tanıda fizik muayene, idrar sitolojisi, üretrosistoskopi ve biyopsi kullanılırken; evreleme için BT, MR ve PET gibi görüntüleme yöntemlerinden yararlanılır. Evreleme TNM sistemine göre yapılır. Genel sağkalım oranları 5 yıllık süreçte %54 civarındadır ve yaş, evre ile anatomik lokalizasyon önemli prognostik faktörler arasındadır. Lokalize hastalıkta tedavi yaklaşımı cinsiyete ve tümörün üretradaki yerine göre değişmekte olup cerrahi rezeksiyon, lazer ablasyon veya radyoterapiyi içermektedir. Lokal ileri evrelerde multimodal tedaviler ve neoadjuvan sisplatin bazlı kemoterapi sağkalımı artırabilirken, metastatik hastalıkta mesane kanseri rejimleri uygulanır. Nadirliği nedeniyle standart bir takip şeması olmamakla birlikte, koruyucu cerrahi sonrası sitoloji, endoskopi ve görüntüleme önerilmektedir.
Primary urethral tumors are highly rare malignancies accounting for less than 1% of all genitourinary cancers, with incidence peaking over the age of 75. The disease is associated with urethral strictures and chronic inflammation in men, and urethral diverticula and recurrent urinary infections in women. Histopathologically, urothelial carcinoma, squamous cell carcinoma, and adenocarcinoma are the most common forms. Most patients present at a locally advanced stage, with hematuria and urethral bleeding being the most prevalent symptoms. Diagnosis utilizes physical examination, urine cytology, urethrocystoscopy, and biopsy, while staging relies on imaging modalities such as CT, MRI, and PET. Staging is performed according to the TNM classification system. The 5-year overall survival rate is around 54%, and age, stage, and anatomical location serve as significant prognostic factors. Treatment for localized disease varies by gender and tumor location, encompassing surgical resection, laser ablation, or radiotherapy. In locally advanced stages, multimodal treatments and neoadjuvant cisplatin-based chemotherapy can improve survival, whereas metastatic disease is managed with bladder cancer regimens. Due to its rarity, no standard follow-up protocol exists, but cytology, endoscopy, and imaging are recommended after bladder-sparing surgery.
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