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

1. Cystoscopy ,
2. 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 ,

1. 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),
2. 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

related articles

• Kidney tumors
• Kidney cancer

External links

• Urolithiasis, urooncology, retroperitoneal diseases, lower urinary tract diseases

Source

• BENEŠ, Jiří. Study materials  [online]. © 2010. [feeling. 16-06-2010]. < http://jirben.wz.cz >.