This document discusses bladder cancer, including its risk factors, symptoms, diagnostic imaging, and treatment. It notes that bladder cancer is mostly epithelial in origin, with transitional cell carcinoma being the most common type. Risk factors include cigarette smoking and exposure to aromatic amines and cyclophosphamides. Symptoms include hematuria, dysuria, and pelvic or flank pain. Diagnostic imaging includes IVU, ultrasound, CT, and MRI to detect and stage the cancer. Treatment depends on the stage, ranging from surgical resection for localized disease to chemotherapy for advanced or metastatic cancer.

1. Dr S.KRITHIKA MDDr I.GURUBHARATH MD PhD

2. INTRODUCTION
 Epithelial in origin (> 90%)
Transitional cell carcinoma
(TCC): 90% (Most
common)
Squamous cell carcinoma
(SCC): 1.5–10%
associated with chronic
 infection (e.g.
schistosomiasis)
 bladder calculi.
Adenocarcinoma: 1% of all
epithelial tumours
 associated with bladder
exstrophy and urachal
remnants
Risk factors:
•Carcinogens present
within cigarette
smoke (the most
important factor)
• aromatic amines
• cyclophosphamides

3. Growth patterns:
 in situ (non-invasive)
 papillary
 infiltrating
 ulcerating
Location:
 commonly around the
region of the trigone
 or along the lateral
bladder walls
SYMPTOMS
 Haematuria
 dysuria
 pelvic pain (due to side
wall invasion)
hydronephrosis (due to
ureteric obstruction)
 6th and 7th decades
(M>F)

4. INTRA VENOUS UROGRAM

5. ULTRASOUND
A sessile or pedunculated mixed
echogenicity mass
projecting into the bladder lumen (+/-
vascularity)

7. CT
 Distant metastases and detecting perivesical fat
invasion (T3b)
 Cannot distinguish between lesions limited to the
lamina propria(T1) and those invading the superficial
(T2a) and deep(T2b) muscle.

8.  A sessile or pedunculated soft tissue mass projecting
into the bladder lumen
 overlying calcification or localized bladder wall thickening
Perivesical fat invasion (T3b):
 poor external bladder wall definition
 increased perivesical fat density
Adjacent visceral invasion (T4a):
No distinct fat plane between the bladder and rectum,
uterus,prostate or vagina
Pelvic side wall invasion (T4b):
soft tissue extending into
 the obturator internus muscle.
 strands of soft tissue extending from the main tumour
mass to the pelvic side wall

9.  Pelvic lymph nodes (N1–N3):
 malignant
 involvement if > 7mm
 Rare in superficial tumours (< T2b)
 Increased incidence with deep muscular involvement
and extravesical spread.
 Pattern of nodal spread:
 obturator and external iliac nodes
 internal and common iliac nodes
 Distant metastases: bone,lungs,brain,liver

13. MRI
 Surface coil imaging (e.g.
endorectal coil) :
 improves the visualization
of the bladder wall layers
 it is better than CT for the
evaluation of tumours at
the bladder base or dome
 for differentiation between
T3a and T4 disease
 T1WI: similar SI to normal
wall ▶ higher SI to urine
 T2WI: higher SI to normal
wall ▶ lower SI to urine
 (T2a) and deep (T2b) can
be differentiated by
assessing the integrity of
the bladder wall ‘black
line’ between the
superficial and deep
muscle layers

14.  T1WI þ Gad: a higher SI relative to normal bladder wall
 Bladder wall tumour or perivesical extension=earlier
enhancement than simple inflammatory post-biopsy
change
 Metastatic lymph nodes=early enhancement than
non-metastatic nodes
 Seminal vesicle invasion:
 T2WI: low SI within the seminal vesicles
 obliteration of the fat angle between the seminal
vesicle and posterior bladder wall

18. TREATMENT
 Tumour confined to the bladder wall or if there is
minimal extravesical spread: surgical resection
 Superficial tumours: intravesical chemotherapy (BCG)
 Extensive extravesical spread: systemic chemotherapy
or palliative radiotherapy
RESPONSE TO THERAPY:
 Dynamic contrast-enhanced MRI: delayed tumour
 Enhancement in patients responding to chemotherapy
 (early enhancement in non-responders

19.  Thank you