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Hematuria and Bladder Cancer Diagnosis and Treatment

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Musfirah Tahir
Musfirah Tahir

lecture by Dr. Ahmed Rehman

Health & Medicine
1 of 53
HEMATURIA and Carcinoma Urinary Bladder
 
Learning Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bladder tumours ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Urothelial tumours ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hematuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3 glass test ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Cause may be any where in urinary tract ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Causes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Causes ,[object Object],[object Object],[object Object],[object Object]
Medical Causes, cause of hematuria may not be in urinary tract but outside it ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Points in history ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Workup ,[object Object],[object Object],[object Object]
flow cytometery ,[object Object],[object Object],[object Object],[object Object]
Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Advantages of US ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Disadvantages US ,[object Object],[object Object],[object Object]
Imaging: US findings ,[object Object],[object Object],[object Object],[object Object]
IVU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IVU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IVU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IVU Findings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Cysto-urethro-scopy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Open excision or biopsy ,[object Object],[object Object],[object Object],[object Object]
Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3 biological behaviral pattrens Non-muscle invasive (superficial) disease Muscle invasive disease Flat noninvasive CIS (primary CIS) pTa, pT1 pT2+ CIS 70% new cases 25% 5% Good prognosis Bad, 5 yr survival 50% Poor unless treated early Recur 70%, invade 15% Invade, metastasize Invade, metastasize Exophytic, papillary Single, multiple Solid, large,1 or more Irregular, ulcerated Flat, velvety mucosa, angry looking vessels Pedunculated (stalk) Broad base Field change +/_ (con CIS) Lamina propria muscularis Intra epithelial Comptete resection Persist on Bim Exam Met death 30-50% 50% deaths mets Down stage/salvage cyst Endoscopic + intravesical Primary surgical treatme Endo+intrrav+/-surgry
Stage wise treatment Stage Description Traetment Tis Ca insitu Complete TURBT Intravesical BCG-> repeat-> RC* Ta Single, low to moderate grade, not recurent Complete TUR alone Ta Large, multiple, high grade, recurrent Complete TUR intravesical chemo- or immunotherapy T1 Complete TUR-> intravesical chemo- or immunotherapy T1G3 Complete TUR ->Intavesical BCG -> repeat ->radical cystectomy T2 ,[object Object],T2-4 ,[object Object],[object Object],[object Object],[object Object],[object Object],Any T, N+, M+ ,[object Object]
Metastatic disease ,[object Object],[object Object],[object Object]
Intravesical Chemo- or Immunotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New Systemic Chemotherapy ,[object Object],[object Object],[object Object]
Radical Cystectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
diversions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Open Procdures / Biopsy ,[object Object],[object Object],[object Object]
Radiation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management of associated problems ,[object Object],[object Object],[object Object],[object Object]
Follow Up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prognosis ,[object Object]
Resident’s Role ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
remember ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hematuria of obscure origin ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Hematuria and Bladder Cancer Diagnosis and Treatment

  • 1. HEMATURIA and Carcinoma Urinary Bladder
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  • 38. 3 biological behaviral pattrens Non-muscle invasive (superficial) disease Muscle invasive disease Flat noninvasive CIS (primary CIS) pTa, pT1 pT2+ CIS 70% new cases 25% 5% Good prognosis Bad, 5 yr survival 50% Poor unless treated early Recur 70%, invade 15% Invade, metastasize Invade, metastasize Exophytic, papillary Single, multiple Solid, large,1 or more Irregular, ulcerated Flat, velvety mucosa, angry looking vessels Pedunculated (stalk) Broad base Field change +/_ (con CIS) Lamina propria muscularis Intra epithelial Comptete resection Persist on Bim Exam Met death 30-50% 50% deaths mets Down stage/salvage cyst Endoscopic + intravesical Primary surgical treatme Endo+intrrav+/-surgry
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