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Bladder Cancer

Highly differentiated urothelial carcinoma

They currently make up more than 2% of newly diagnosed malignancies.

Epidemiology

Morbidity is still rising, mortality is decreasing, it affects men 3 times more often ,
high incidence - in SW Europe, low in India and Japan,
the main occurrence is between the 50s and 70s.

Etiology

The main risk factor is smoking (mainly black tobacco smoking),
exposure to certain industrial pollutants - aromatic amines (benzidine, 2-naphthylamine,…),
chronic infection, in endemic areas - schistosomiasis (does mainly squamous cell ca).

Clinical manifestations

Hematuria and pollakiuria ,
increased bladder irritation indicates involvement of the throat, hydronephrosis and secondary pyelonephritis may occur in the area of the urethral orifice ,
sometimes it can be completely asymptomatic,
general symptoms (anorexia, weight loss, anemia ) - are only in very advanced tumors.

Diagnostics

Cystoscopy ,
endoscopic biopsy , or transurethral resection → it is necessary to determine the level.

Histopathology

97% are carcinomas from the urothelium , rarely adenocarcinomas and undifferentiated carcinomas , squamous cell carcinomas are endemic (schistosomiasis),
macro - different appearance - papillary, infiltrating, probably in ¼ they arise multicentricly (this is the cause of frequent recurrences),
they can start as ca in situ and then change into a papillary or infiltrating form,
initially the tumor grows in the mucosa, then grows early into the submucosa, muscle and surrounding fat, metastasizes to the pelvic nodes , later paraaortic , more rarely hematogenously.

Therapy

The method of therapy depends on a careful evaluation of histology, degree of invasion, extent of the disease.

Surgical treatment

Non-invasive tumors can be treated by transurethral resection (TUR) - it is a relatively minor damaging procedure, it does not affect bladder function,
for the treatment of surface structures - coagulation or laser vaporization ,
but often there is a recurrence within 1 year, so the five-year survival does not exceed 80%,
therefore, it is recommended to supplement adjuvant intravesical CHT, intravesical application of IFN, BCG vaccine, adriamycin, irradiation,
if the tumor grows into the muscle - partial cystectomy ,
- the rationality of this procedure is questioned given the multifocal origin of urothelial
- moreover, there is a risk of implantation targets, so it is practically not implemented today,
for larger tumors - radical cystectomy with lymphadenectomy , in men with prostatectomy in women with hysterectomy , adnexectomy ,
- it is a very demanding performance and its indications must be carefully considered.

Radiotherapy

It is most often not used as an external radiation, as a separate treatment, for numerous emergency services,
even as a neoadjuvant , no significant effect has been confirmed,
So far, radiochemotherapy (RCHT) could have a good effect, but this is not substantiated by studies
however, it is irreplaceable as palliation (skeletal meta analgesia, suppression of hemorrhagic complications).

Chemotherapy

It is administered either locally or systemically ,

local - in diffuse ca in situ, in superficial tumors after TUR and in papillary (the most advantageous today seems mitomycin C , which is practically not absorbed from the bladder and does not endanger toxicity),
systemic - the main palliative treatment of advanced forms, the tumor responds to a number of cytostatics,

corresponds most to - Pt derivatives, anthracyclines, ifosfamide ,
- adjuvant CHT - very useful especially for nodal involvement,
- neoadjuvance - has many disadvantages, it is not done by default.

Photodynamic therapy

It can act in ca in situ and in papillary ca.

Immunotherapy

Mainly in the form of local application of BCG .

Prognosis

In non-invasives, 5-year survival is 75-80%.

Links

External links

Urolithiasis, urooncology, retroperitoneal diseases, lower urinary tract diseases

Source

@@ Line 2: / Line 2: @@
 == '''Bladder Cancer''' ==
+[[File:Urothelial papillary carcinoma highly differentiated (urinary bladder)H&E magn 200x.jpg|thumb|Highly differentiated urothelial carcinoma]]
+They currently make up more than 2% of newly diagnosed malignancies.
-- Second most common genitourinary tract malignity
+== Epidemiology ==
-- Male-female ratio = 3:1
+* Morbidity is still rising, mortality is decreasing, it affects '''men 3 times more often''' ,
+* high incidence - in SW Europe, low in India and Japan,
+* the main occurrence is between the 50s and 70s.
-- Peak ~ 60-70 years of age
+== Etiology ==
+* The main risk factor is '''smoking''' (mainly black tobacco smoking),
+* exposure to certain industrial pollutants - '''aromatic amines''' (benzidine, 2-naphthylamine,…),
+* chronic infection, in endemic areas - [[schistosomiasis]] (does mainly squamous cell ca).
-'''Aetiology'''
+== Clinical manifestations ==
--	Chemicals (e.g.: benzidine, aniline dyes, cyclophosphamide)
+* [[Hematuria]] and [[pollakiuria]] ,
+* increased bladder irritation indicates involvement of the throat, [[hydronephrosis]] and secondary [[pyelonephritis]] may occur in the area of the urethral orifice ,
+* sometimes it can be completely asymptomatic,
+* general symptoms (anorexia, weight loss, [[anemia]] ) - are only in very advanced tumors.
--	Smoking
+== Diagnostics ==
--	Chronic irritation of mucosa (chronic inflammation, lithiasis, schistosomiasis)
+# [[Cystoscopy]] ,
+# endoscopic [[biopsy]] , or transurethral resection → it is necessary to determine the level.
--	Often associated the Balkan nephropathy (which is labelled as precancerosis)
+== Histopathology ==
--	Analgesic (phenacetin) abuse (more frequent formerly)
+* 97% are '''carcinomas from the urothelium''' , rarely '''adenocarcinomas''' and '''undifferentiated carcinomas''' , '''squamous cell''' carcinomas are endemic (schistosomiasis),
+* macro - different appearance - papillary, infiltrating, probably in ¼ they arise multicentricly (this is the cause of frequent recurrences),
+* they can start as ca in situ and then change into a '''''papillary''''' or '''''infiltrating'' form''',
+* initially the tumor grows in the mucosa, then grows early into the submucosa, muscle and surrounding fat, metastasizes to the '''pelvic nodes''' , later '''paraaortic''' , more rarely hematogenously.
+== Therapy ==
+The method of therapy depends on a careful evaluation of histology, degree of invasion, extent of the disease.
+=== Surgical treatment ===
-'''Pathology'''
+* Non-invasive tumors can be treated by '''[[Transurethral resection|transurethral resection (TUR)]]''' - it is a relatively minor damaging procedure, it does not affect bladder function,
+* for the treatment of surface structures - '''coagulation''' or '''laser vaporization''' ,
+* but often there is a recurrence within 1 year, so the five-year survival does not exceed 80%,
+* therefore, it is recommended to supplement adjuvant intravesical CHT, intravesical application of IFN, BCG vaccine, adriamycin, irradiation,
+* if the tumor grows into the muscle - '''partial [[cystectomy]]''' ,
+** the rationality of this procedure is questioned given the multifocal origin of urothelial
+** moreover, there is a risk of implantation targets, so it is practically not implemented today,
+* for larger tumors - '''radical cystectomy with lymphadenectomy''' , in men with [[prostatectomy]] in women with [[hysterectomy]] , [[adnexectomy]] ,
+** it is a very demanding performance and its indications must be carefully considered.
--	98% epithelial tumours of malignant or benign origin. Mesenchymal tumours are rare (sarcoma, lymphoma)
+=== Radiotherapy ===
-a)	Benign: urothelial papilloma, squamous papilloma
+* It is most often not used as an external radiation, as a separate treatment, for numerous emergency services,
+* even as a [[neoadjuvant]] , no significant effect has been confirmed,
+* So far, radiochemotherapy (RCHT) could have a good effect, but this is not substantiated by studies
+* however, it is irreplaceable as [[palliation]] (skeletal meta analgesia, suppression of hemorrhagic complications).
-b)	Malignant: Urothelial carcinoma (90%), Epidermoid carcinoma (7%), Adenocarcinoma (2%)
+=== Chemotherapy ===
+* It is administered either '''locally''' or '''systemically''' ,
-'''Staging'''
+# local - in diffuse ca in situ, in superficial tumors after TUR and in papillary (the most advantageous today seems '''mitomycin C''' , which is practically not absorbed from the bladder and does not endanger toxicity),
+# systemic - the main '''palliative treatment''' of advanced forms, the tumor responds to a number of cytostatics,
-Table 2002 TNM staging of bladder carcinoma [1]
+* corresponds most to - '''Pt derivatives, anthracyclines, ifosfamide''' ,
+** adjuvant CHT - very useful especially for nodal involvement,
+** neoadjuvance - has many disadvantages, it is not done by default.
-Tx Primary tumor cannot be assessed
+=== Photodynamic therapy ===
-T0 No evidence of primary tumor
+* It can act in ca in situ and in papillary ca.
-Ta Noninvasive papillary carcinoma
+=== Immunotherapy ===
-Tis Carcinoma in situ
+* Mainly in the form of '''local application of [[BCG]]''' .
-T1 Tumor invades subepithelial connective tissue
+== Prognosis ==
-T2 Tumor invades muscularis propria (detrusor): T2a inner half; T2b outer half
+* In non-invasives, 5-year survival is 75-80%.
-T3 Tumor invades beyond muscularis propria into perivesical fat:
+== Links ==
-T3a = microscopic; T3b = macroscopic (extravesical mass)
+=== related articles ===
-T4a Tumor invades any of prostate, uterus, vagina, bowel
+* [[Kidney tumors]]
+* [[Kidney cancer]]
-T4b Tumor invades pelvic or abdominal wall
+=== External links ===
-Nx Regional (iliac and para-aortic) lymph nodes cannot be assessed
+* [[Urolithiasis, urooncology, retroperitoneal diseases, lower urinary tract diseases]]
-N0 No regional lymph node metastasis
+=== Source ===
-N1 Metastasis in a single lymph node <2 cm in greatest dimension
+* BENEŠ, Jiří. ''Study materials''  [online]. © 2010. [feeling. 16-06-2010]. < <nowiki>http://jirben.wz.cz</nowiki> >.
-N2 Metastasis in a single lymph node 2–5 cm or multiple nodes <5 cm
+[[Category:Oncology]]
+[[Category:Urology]]
-N3 Metastasis in a single lymph node or multiple nodes >5 cm in greatest dimension
+[[Category:Nephrology]]
+[[Category:Internal medicine]]
-Mx Distant metastasis cannot be assessed
+[[Category:Pathology]]
-M0 No distant metastasis
-M1 Distant metastasis present
-'''Symptoms'''
--	Haematuria in 85-90% of patients (painless)
--	Vesical irritability: frequency, urgency, and dysuria
--	In advanced disease: bone pain (from metastases), flank pain (from retroperitoneal metastases), or ureteral obstruction
-'''Diagnosis'''
--	Physical findings: rectal / Vaginal examintation --> palpable tumour
--	Laboratory: FW↑, BC↓, Urea↑, Creatinine↑
--	Cytology: tumour cells in urine --> staging
--	Flow cytometry
--	Tumour markers: BTA test (bladder tumor antigen)
--	X-Ray, IVU, Ultrasound, CT, MRI, Scintigraphy --> staging, metastes, etc
--	Cystoscopy + transurethral resection (biopsy) = TURB --> possibly with Fluorescence cystoscopy using blue light after application of 5-ALA
-'''Treatment'''
-)	Superficial tumours
--	Transurethral resection --> electroresection or laser technology
--	Prophylaxis of tumour recurrence: local chemotherapy or immunotherapy (BCG-vaccine!)
--	Cystectomy + urine diversion: only if ≥ 50% of bladder mucosa is affected
-)	Infiltrative Tumours
--	Partial resection
--	Radical resection + urine diversion: in men --> prostate, seminal vesicles must also be removed // in women --> uterus, tubes, ovaries and part of the anterior
-vaginal wall must also be remove
-Urinary diversion --> several surgical techniques possible. Several include the creation of a neobladder out of intestines. If possible, the urethra can be attached through
-anastomis to the neobladder.
-'''References'''
-.	Oxford American Handbook of Urology - David M. Albala, Allen F. Morey, Leonard G. Gomella, John P. Stein
-.	Textbook of urology – Zbyněk Veselský et al.
-.	Smith’s General Urology – Emil A. Tanagho, Jack W. McAnich (17th edition)