BLADDER CARSINOMAS

AZIF ZILAL FAUQI

INCIDENS
Bladder cancer is the second most common cancer of the genitourinary tract.
The average age at diagnosis is 65 years.
At that time, approximately 75% of bladder cancers are localized to the bladder, 25% have
spread to regional lymph nodes or distant sites.
Risk Factors and Pathogenesis
Cigarette smoking
The causative agents are thought to be alpha – and beta naphthylamine which are secreted into
the urine of smokers.
Occupational Exposure
Workers in the chemical, dye, rubber, petroleum, leather, and printing industries are at increased
risk.
Specific occupational carcinogens include benzidine, beta-naphthylamine, and 4-aminobiphenyl
Con’t......
Physical trauma to the urothelium induced by infection increases the risk of malignancy
Patient who have received cyclophosphamide (Cytoxan) for the management of various
malignant are also at increased risk
Genetic
The exact genetic events leading to the development of bladder cancer are unknown, but they
are likely to be multiple and may involve the activation of oncogenes and inactivation or loss of
tumor suppressor genes
Staging
Histopathology
Ninety five percent of all bladder cancers are epithelial malignancies, with predominant majority
being transitional cell carcinomas (TCCs). About 5% are adenocarcinomas or squamous cell
carcinomas.
Clinical Findings
SYMPTOMS
1. Hematuria It may be gross or microscopic, intermittent rather than constant
2. Painless
3. Vesical irritability such as frequency, urgency, dysuria
4. Bone pain  from bone metastases
5. Flank pain  from retroperitoneal metastases or ureteral obstruction
Con’t....
SIGNS
1. Patients with large volume or invasive tumors may be found to have bladder wall thickening
or palpable mass (findings that may be detected on careful bimanual exam under anesthesia)
2. Hepatomegaly and supraclavicular lymphadenopathy are signs of metastatic disease
3. Lymphedema from occlusive pelvic lymphadenopathy may be seen occasionally
Laboratory Findings
1. Routine testing
Hematuria.
2. Urinary cytology
Exfoliated cells from both normal and neoplastic urothelium can be readily identified in voided urine.
3. Imaging
Intravenous urography
CT urography which is more accurate, for evaluation of the entire abdominal cavity, renal
parenchyma, and ureters in patients with hematuria.
MRI
Both CT and MRI have been used to characterize the extent of bladder wall invasion, and detect
enlarged pelvic lymph nodes, with overall staging accuracy ranging from 40% to 85% for CT, and from
50%-90% for MRI
Con’t....
4. Cystourethroscopy and Tumor Resection
Once a tumor is visualized or suspected, the patient is scheduled for examination under
anesthesia and TUR or biopsy of the suspicious lession. The objectives are tumor diagnosis,
assessment of the degree of bladder wall invasion (staging), and complete excision of the low
stage lessions amenable to such treatment.
Treatment
A. INTRAVESICAL CHEMOTHERAPY
- Mitomycin C
- Thiotepa
- BCG
B. SURGERY
1. TUR  Patient with single, low-grade, non invasive tumors may be treated with TUR alone, those
with superficial disease but high risk feature should be treated with TUR followed by selective use of
intravesical therapy.
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
3. Radical Cystectomy
Con’t....
C. Radiotherapy
D. Chemotherapy
For patients whe present with Bladder cancer and have found regional or distant metastases
TERIMAKASIH.....