learn about cancer of the bladder: from A-Z

2. RISKS FACTORS OF BLADDER CA
• Schistosoma hematobium infection
• Cigarette smoking
• Industrial chemicals: dye workers, hair dyes
• Chronic bladder infection
• Bladder calculi
• Long term in dwelling catheter

3. Risk factors Cont’d
• Radiation exposure
• Use of cyclophosphamide
• Past history of upper urothelial cancers

4. Pathology (Macroscopic)
• Papillary (Pedunculated): most common form of the
tumor.
• Solid (sessile)

5. Pathology (Microscopic)
• Transitional cell carcinoma
• Squamous cell carcinoma
• Adenocarcinoma
• Rhabdomyosarcoma
• Lymphoma
• Melanoma

6. Clinical Features Of Bladder Ca
• Painless hematuria 75% ( total or terminal)
• Symptoms of bladder irritation (frequency, urgency,
nocturia) from supervening infection.
• Voiding symptoms ( when bladder neck is involved)
• Pedal edema (from venous or lymphatic obstruction)

7. Clinical features of bladder Ca
• Flank pain (ureteric orifice involvement)
• Pain in pelvis and rectum (from local spread)
• Weight loss, malaise, bone pain, palpitation,dizziness.
• Suprapubic mass (from either large tumor or urinary
retention)

8. Physical Examinations
• General Examination
Weight loss
Pallor
Pedal edema

9. Physical Examination
• Palpable and tender kidneys
• VE: reveal mass at the bass of the bladder
• RE: invasive mass in the region of the trig one
• Palpable abdominal masses( metastases to lymph
node)
• Oedema of lower limb
• Bimanual palpation of bladder under anaesthesia

10. Investigations In Bladder Ca
• FBC ( reduced Hb, increased WBC)
• Urine culture ( may show infection)
• Urine cytology (tumor cells)

11. Investigations
• Abdominopelvic USG (Hydronephrosis, bladder mass)
• CT Scan or MRI (helps assess stage of disease)
• Cystoscopy
Surface appearance ( Pedunculated/sessile, ulcerated,
hemorrhagic, etc)
Position: base, wall, relationship with ureter)
Size, Number of masses

12. UICC Staging of Bladder Ca
• Superficial Tumour
Tis: Carcinoma in situ
Ta: Papillary non-invasive carcinoma
T1: invasive of submucosa

13. Muscle- invasive tumour
• T2: Tumour invades muscle
T2a: invasion of superficial muscle
T2b: Invasion of deep muscle
• T3: Tumour invades perivesical tissues
T3a: microscopic invasion
T3b: Macroscopic invasion
• T4: Invasion of contiguous organs.
T4a: Invasion of prostate, uterus, cervix, or vagina
T4b: Fixed/ invasion of pelvic or abdominal wall

14. Lymph Node
• N1: Single <2cm
• N2: single >2cm <5cm, multiple <5cm
• N3: >5cm
• M1: Distant metastases

15. • Choice of treatment depends on :
State of infiltration
The cell type
The grade of cell differentiation
The accessibility
The size and number of tumors
The age and clinical condition of patient

16. Treatment of TCC
1. Non-muscle invasive Tumour
Transurethral resection of bladder Tumour (TURBT)
Intravesical chemotherapy( mitomycin C, Doxorubicin, Thiotepa)
Immunotherapy (BCG)
2. Muscle –invasive Tumor
Partial cystectomy
Radical cystectomy +bilateral pelvic and iliac lymphadenectomy with urinary
diversion.
Neo-Adjuvant chemotherapy ( Cisplatin) + radical cystectomy and urinary
diversion
External beam radiotherapy.

17. Treatment of SCC
• Radical cystectomy with or without radiotherapy
• Treatment of Sarcoma: Combined radical total
cystectomy + chemotherapy
• Treatment of Adenocarcinoma: radical cystectomy
+urinary diversion

18. Follow Up
• Cystoscopy and bimanual exams: every 3 months for
the 1st year and every 6months for the 2nd year and
thereafter annually
• Annual CT scan or IVU
• Urine cytology: every 3 months
• USG and MRI

19. Complications of Bladder Tumour
• Hemorrhage and anaemia
• Cystitis
• Progressive Hydronephrosis and hydroureter
• Urine retention
• Fistula
• Constipation/diarrhea/ acute intestinal obstruction
from bowel infiltration.

20. Complications
• Intractable pain from pelvic nerve plexus infiltration
• Unilateral or bilateral lower limb edema
• Priapism from spread to base of penis

21. Treatment of Bladder Tumour
1. Treatment of Non- muscle –invasisive Disease (Ta,
T1, CIS)
2. Treatment of Muscle –Invasive- dIsease (T2 and
Greater)