Urinary Bladder Carcinoma

Urinary Bladder Carcinoma

1. signs and symptoms

   • hematuria
     • physiology of hematuria
       • initial
         • Urethra
       • total
         • bladder or upper UT
       • end
         • Bladder neck or prostate urethra
       • causes: differential diagnosis
         • pain
           • UTI
           • stones
         • without pain
           • glomerulonephritis
           • schistosomiasis
         • either
           • UTI
           • APCKD
         • Grading
   • urgency
   • frequency
   • weight loss and fatigue
   • peripheral swelling

2. causes

   • schistosoma
     • chronic cystitis
       • HPV
   • smoking

3. risk factors

   • occupational
     • aniline
       • Taxi drivers
   • Past exposure to radiation
     • type 2 diabetes treatment

4. prognosis (5 year)

   • stage 0
     • 98%
       • stage 2
         • 63%
           • stage 4
             • 15%
               • overall survival
                 • 5 year: 77%
                   • 10 year: 70%
                     • 15 year: 65%
                 • ALWAYS follow up with transurethral removal of bladder tumor (TURBT)
   • stage 1
     • 88%
       • stage 3
         • 46%

5. diagnosis

   • imaging
     • US
       • Cytoscopy
   • histopathology
     • grading
       • high grade
         • well differentiated
           • low grade
             • poorly differnentiated
     • staging
       • stage 0
         • cis
           • flat on the mucosal linning
         • Papillary 0a
           • Papillary on mucosal linning
         • stage 1
           • invades the submucosa
           • stage 2
             • invade the muscle layer
             • stage 3
               • invades the surrounding fat
               • stage 4
                 • invade the surrounding tissues
     • cytology
       • Detect highly malignant cells (like CIS)
       • schistoma hematobium egges
     • Papillary varient

6. lab investigations

   • PSA
     • test for prostatic cancer and BPH
       • can cause UTI symptoms
       • normal level: up to 4ng/ml of blood
         • other investigations were disscussed in details in previous PBL's

7. management

   • stage 0
     • a(papillary)
       • mitomyocin
     • in situ
       • BCG
     • stage 1
       • low grade
         • BCG
       • high grade
         • radical cystectomy
       • stage 2 & 3
         • radical cystectomy
         • stage 4
           • chemotherapy

8. Physiology of micturation

   • during bladder filling
     • sympathetic (L1-L3) dominate
       • Relax detrusor muscle
       • stimulate the internal sphincter
       • during bladder emptying
         • parasympthatic (S2-S4) dominate
           • contract detrusor muscle
           • inhibit the internal sphincter
           • there must be somatic relaxation of external sphincter in order of voiding to happen
             • by pudendal nerve (S3-S4)

9. epidemiology

   • MC malignancy in UTI
   • 9th MC malignancy
   • types
     • urothelial
       • in america and europe
         • MC risk factor: smoking
     • non-urothelial
       • in middle east
         • MC risk fsctor: schistosoma hemabotium
           • A cestode parasitic infection
             • increases carcinogen-metabolizing enzymes
               • +++N-nitrosamines
                 • alkylating DNA damage
                   • metaplasia and carcinoma

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