Transcript BLADDER CARCINOMAS

Bladder tumor
dr,mohamed fawzi alshahwani
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facts
• Bladder cancer is the second most common
cancer of the genitourinary tract.
• Bladder cancer three times more common
in men .
• The average age at diagnosis is 65 years.
• At the time of diagnosis , approximately
75% of bladder cancers are localized to the
bladder; 25% have spread to regional lymph
nodes or distant sites.
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Risk Factors & Pathogenesis
1) Cigarette smoking
2 )Occupational exposure . Workers in the
chemical, rubber, petroleum, leather, and
printing industries
3- Pelvic Irradiation.
4- Cyclophosphamide.
5- physical trauma to the urothelium induced
by infection, instrumentation, and calculi .
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Histopathology
• Ninety-eight percent are epithelial , with
most being transitional cell carcinomas
1- Transitional Cell Carcinoma (TCC):
• commonly appear as papillary, ; less commonly,
sessile or ulcerated.
• Carcinoma in situ (CIS) is recognizable as flat,
anaplastic epithelium.
2- Adenocarcinoma: account for <2% .
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Secondary bladder tumors:
• Cancers of the prostate, cervix, and rectum
may involve the bladder by direct extension.
• The most common tumors metastatic to the
bladder include melanoma, lymphoma,
stomach, breast, kidney, lung and liver .
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Clinical Findings
A. SYMPTOMS:
• Hematuria 85–90% of patients with bladder
cancer usually painless.
• Symptoms of advanced disease include
bone pain from bone metastases or flank
pain from retroperitoneal metastases or
ureteral obstruction
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LABORATORY FINDINGS
1. Routine testing
GUE…….. Hematuria most common ….
pyuria,.. from concomitant UTIs
• Azotemia in patients with ureteral occlusion
owing to the primary tumor or
lymphadenopathy.
• Anemia may be a presenting symptom
owing to chronic blood loss, or replacement
of the bone marrow with metastatic
disease.
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2. Urinary cytology:
3. Other markers: Commercially
available tests include, the BTA test
and NMP22.
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4- Imaging Studies:
• A- IVU.
• B- U/S.
• C- CT. SCAN , MRI.
• D- chest x-ray and radionuclide bone
scan.
5..difinit diagnosis by cystoscopy and
biobsy
IVU
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MRI
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TREATMENT
• Once a tumor is visualized or suspected, the
patient is scheduled for examination under
anesthesia and TURT and biopsy of the
suspicious lesion.
• The objectives of TURT are
1 tumor diagnosis,
2 assessment of the degree of bladder wall
invasion (staging),
3 and complete excision of the lesions.
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TURT
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TREATMENT
SUPERFECIAL BT (Ta , T1 )
Small,low grade ,single,
TURT then check scope every
three months
SUPERFECIAL BT (Ta , T1 )
large, multiples ,high grade ,associated
CIS, recurrent
TURT,intrasical
,and check scope
months
chimotherapy
every three
DEEP BT (T2-T4)
Radical cystectomy with
urinary diversion
(radiotherapy for unfit
patient)
METASTATIC TUMOR
Systemic chimotherapy
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Treatment
intravasical chimotherapy
Immunotherapeutic (Bacillus Calmette- •
Guérin BCG) or chemotherapeutic agents
(mitomycin C, thiotepa , and Gemcitabin)
can be instilled into the bladder directly via
catheter, thereby avoiding the morbidity of
systemic administration in most cases.
Most agents are administered weekly for 6 •
weeks .
B. SURGERY
• 1. TURT : is the initial form of treatment for
all bladder cancers. It allows a reasonably
accurate estimate of tumor stage and grade
and the need for additional treatment.
• Patients who presented initially with multiple
or higher grade lesions (or both) and those
who have recurrences at 3 months require
more careful surveillance. In such patients,
cystoscopy at 3-month intervals is necessary.
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Complications of TURBT:
Bleeding , Clot Retention And •
Bladder Perforation.
2. Partial cystectomy:
• Patients with solitary, infiltrating tumors (T1–
T3) localized along the posterior lateral wall or
dome of the bladder are candidates for partial
cystectomy, as are patients with cancers in a
diverticulum.
3. Radical cystectomy and Urinary diversion:
• implies removal of the anterior pelvic organs:
in men, the bladder with its surrounding fat
and peritoneal attachments, the prostate, and
the seminal vesicles;
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• in women, the bladder and
surrounding fat and peritoneal
attachments, cervix, uterus, anterior
vaginal vault, urethra, and ovaries.
• This remains the “gold standard” of
treatment for patients with muscle
invasive bladder cancer
•
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CHEMOTHERAPY
• 15% of patients who present with
bladder cancer have regional or distant
metastases.
• The regimen of methotrexate,
vinblastine, doxorubicin (Adriamycin),
and cisplatin (MVAC) has been the most
commonly used.
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