Urinary Bladder Carcinoma

signs and symptoms
1. hematuria
  1. physiology of hematuria
    1. initial
      1. Urethra
    2. total
      1. bladder or upper UT
    3. end
      1. Bladder neck or prostate urethra
    4. causes: differential diagnosis
      1. pain
        UTI
        stones
      2. without pain
        glomerulonephritis
        schistosomiasis
      3. either
        UTI
        APCKD
      4. Grading
2. urgency
3. frequency
4. weight loss and fatigue
5. peripheral swelling
causes
1. schistosoma
  1. chronic cystitis
    1. HPV
2. smoking
risk factors
1. occupational
  1. aniline
    1. Taxi drivers
2. Past exposure to radiation
  1. type 2 diabetes treatment
prognosis (5 year)
1. stage 0
  1. 98%
    1. stage 2
      1. 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)
2. stage 1
  1. 88%
    1. stage 3
      1. 46%
diagnosis
1. imaging
  1. US
    2. Cytoscopy
2. histopathology
  1. grading
    1. high grade
      1. well differentiated
        low grade
        poorly differnentiated
  2. staging
    1. stage 0
      1. cis
        flat on the mucosal linning
      2. Papillary 0a
        Papillary on mucosal linning
      3. stage 1
        invades the submucosa
        stage 2
        invade the muscle layer
        stage 3
        invades the surrounding fat
        stage 4
        invade the surrounding tissues
  3. cytology
    1. Detect highly malignant cells (like CIS)
    2. schistoma hematobium egges
  4. Papillary varient
lab investigations
1. PSA
  1. test for prostatic cancer and BPH
    1. can cause UTI symptoms
    2. normal level: up to 4ng/ml of blood
      1. other investigations were disscussed in details in previous PBL's
management
1. stage 0
  1. a(papillary)
    1. mitomyocin
  2. in situ
    1. BCG
  3. stage 1
    1. low grade
      1. BCG
    2. high grade
      1. radical cystectomy
    3. stage 2 & 3
      1. radical cystectomy
      2. stage 4
        chemotherapy
Physiology of micturation
1. during bladder filling
  1. sympathetic (L1-L3) dominate
    1. Relax detrusor muscle
    2. stimulate the internal sphincter
    3. during bladder emptying
      1. 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)
epidemiology
1. MC malignancy in UTI
2. 9th MC malignancy
3. types
  1. urothelial
    1. in america and europe
      1. MC risk factor: smoking
  2. non-urothelial
    1. in middle east
      1. 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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Urinary Bladder Carcinoma

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	Created by yousaf alabrash almost 7 years ago