Genito-urinary tumours

Abstract

Genito-urinary tumours can be divided into tumours of the urinary tract and tumours of the genital organs. Renal and ovarian tumours will be excluded from this chapter and we will focus on bladder-prostate tumours, female genital tract (vulva, vagina and uterus) and scrotal tumours (testicular and paratesticular tumours). Bladder prostate tumours mainly consist of malignant mesenchymal tumours especially rhabdomyosarcoma. These tumours are usually chemosensitive and chemotherapy represents the first step of treatment. Local treatment is challenging in term of bladder function and late sequelae with an attempt to perform conservative surgical procedures associated or not with radiotherapy. Due to the very young age of the patients (median: 2 years), radiotherapy is best represented by brachytherapy. Eighty per cent of the patients with localized disease will be cured by the multidisciplinary treatment, with a permanent attempt to decrease the burden of therapy. Malignant tumours of the female genital tract tumours (mainly rhabdomyosarcoma and vitellin tumours) are also very challenging in term of local control. They are also very sensitive to chemotherapy. In SIOP studies, 40 % of girls with RMS are cured without local treatment. Brachytherapy is the most interesting local treatment in case of residual disease after chemotherapy, with 90 % of cure rate and less than 20 % of vaginal stenosis, avoiding total vaginectomy and hysterectomy. Scrotal tumours in prepubertal males are mainly testicular tumours, often benign (teratoma, stromal tumours) allowing to perform testis sparing surgery. For malignant tumours (germ cell tumours of the testis and paratesticular rhabdomyosarcoma), an adequate surgical procedure at diagnosis is mandatory (inguinal orchidectomy with high ligation of cord, avoiding scrotal contamination) to cure the patients without increasing post operative chemotherapy for inadequate surgical procedure. Prognosis is excellent for young males, worse for adolescents who often develop nodal metastasis. In conclusion, local treatment is a key point in the multidisciplinary approach of genito-urinary tumours in children. The goal to decrease the burden of therapy and avoid long term sequelae without jeopardizing survival is obtained by adequate surgical procedures, associated or not with complementary radiotherapy techniques.