346 Ch 345. Renal Cell Carcinoma, Bladder Cancer, and Urologic Malignancies

Urologic cancers 涵蓋：(1) renal cell carcinoma (RCC) — 90% adult kidney malignancy，clear cell most common (75%, VHL gene)，其他 papillary, chromophobe, collecting duct, MiT family；(2) bladder cancer — urothelial carcinoma (transitional cell) most common (90%)，squamous (schistosomiasis-related), adenocarcinoma；(3) prostate cancer — most common male cancer in many countries；(4) testicular cancer — young men；germ cell (seminoma, NSGCT)；(5) upper tract urothelial carcinoma (UTUC) — ureter/renal pelvis；RCC presentation：classic triad (flank pain + hematuria + abdominal mass) rare; mostly incidental (50%) + paraneoplastic syndromes (hypercalcemia, polycythemia, HTN)；bladder cancer：painless gross hematuria 80% — workup with cystoscopy + cytology + imaging；RCC treatment：localized → surgery (partial nephrectomy preferred); metastatic → TKI + immunotherapy combination (Lenvatinib + pembrolizumab, axitinib + pembrolizumab, cabozantinib + nivolumab — CheckMate 9ER, KEYNOTE-426)；bladder cancer：non-muscle invasive (TURBT + intravesical BCG / chemo); muscle-invasive (radical cystectomy + neoadjuvant chemo + IO emerging); metastatic (cisplatin chemo + enfortumab vedotin + pembrolizumab EV-302 2024 paradigm-shifting)。