Bladder mass clinical features & staging
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Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
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Bladder mass clinical features & staging
- 1. CARCINOMA URINARY BLADDER CLINICAL FEATURES & STAGING By Dr. Muhammad Saifullah Post-Graduate Resident (FINAL YEAR) Department of Urology & Renal Transplantation Allied Hospital, Faisalabad.
- 4. HEMATURIA Hematuria is the presenting symptom in 85–90% of patients Gross or microscopic Intermittent rather than constant
- 5. IRRITATIVE SYMPTOMS •Vesical irritability •Frequency •Urgency •Dysuria Irritative voiding symptoms….. common in patients with diffuse CIS.
- 6. CLINICAL FEATURES Advanced disease… • Bone pain….. Metastases
- 7. CLINICAL FEATURES Advanced disease… • Flank pain….. retroperitoneal metastases / ureteral obstruction.
- 8. SIGNS Asymptomatic….. If not muscle invasive!
- 9. WHY STAGING THE DISEASES IS NECESSARY?
- 10. 1. TREATMENT OPTIONS 2. PROGNOSIS
- 11. STAGING
- 12. PAPILLARY VS FLAT GROWTHS
- 13. STAGING PRIMARY TUMOUR •Tx….. Primary tumour cannot be assessed •To….. No evidence of primary tumour •Tis….. Carcinoma in situ: ‘flat tumour’
- 14. STAGING
- 15. STAGING PRIMARY TUMOUR •Ta….. Non-invasive papillary carcinoma
- 16. STAGING
- 17. STAGING PRIMARY TUMOUR •T1….. Tumour invades subepithelial connective tissue
- 18. STAGING
- 19. STAGING T2….. Tumour invades muscle •T2a….. Tumour invades superficial muscle (inner half) •T2b….. Tumour invades deep muscle (outer half)
- 20. STAGING
- 21. STAGING T3….. Tumour invades perivesical tissue •T3a….. Microscopically •T3b….. Macroscopically (extravesical mass)
- 22. STAGING
- 23. STAGING T4….. Tumour invades any of the following: prostate, uterus, vagina, pelvic wall, abdominal wall •T4a….. Tumour invades prostate, uterus or vagina •T4b….. Tumour invades pelvic wall or abdominal wall
- 25. STAGING N….. Lymph nodes •Nx….. Regional lymph nodes cannot be assessed •No..... No regional lymph node metastasis
- 26. STAGING Lymph nodes •N1….. Metastasis in a single lymph node in the true pelvis HYPOGASTRIC, OBTURATOR, EXTERNAL ILIAC, PRESACRAL…..
- 29. STAGING H….. Hypogastric O….. Obturator P….. Presacral E….. External Iliac
- 31. STAGING •N2….. Metastasis in multiple lymph nodes in the true pelvis (hypogastric, obturator, external iliac, or presacral) •N3….. Metastasis in common iliac lymph node(s)
- 32. STAGING M - Distant metastasis •Mx….. Distant metastasis cannot be assessed •Mo….. No distant metastasis •M1….. Distant metastasis
- 33. METASTASIS Transitional cell carcinoma (TCC) of the bladder commonly metastasizes to the i. Lungs ii. Liver iii. Bones iv. Adrenals v. brain.
- 34. METASTASIS Unusual sites include the heart, kidney, spleen, pancreas, and reproductive system.
- 35. STAGE OF BLADDER CANCER AT PRESENTATION
- 36. GRADING
- 37. GRADING….. WHO GRADING IN 1973 •Urothelial papilloma •Grade 1: well differentiated •Grade 2: moderately differentiated •Grade 3: poorly differentiated
- 38. GRADING….. WHO GRADING IN 2004 •Urothelial papilloma (completely benign lesion) •Papillary urothelial neoplasm of low malignant potential (PUNLMP) •Low-grade (LG) papillary urothelial carcinoma •High-grade (HG) papillary urothelial carcinoma
- 39. WHO GRADING IN 1973 VS 2004
- 40. WHO GRADING IN 1973 VS 2004
- 42. RECURRENCE …..
- 43. RECURRENT BLADDER CARCINOMA • Bladder cancer has the highest recurrence rate of any malignancy (ie, 70% within 5 y). • The underlying genetic changes that result in a bladder tumor occur in the entire urothelium, making the whole lining of the urinary system susceptible to tumor recurrence.
- 44. RECURRENT BLADDER CARCINOMA Risk factors for recurrence and progression include the following: Female sex Larger tumor size Multifocality Larger number of tumors High tumor grade Advanced stage Presence of Cis
- 45. RECURRENT BLADDER CARCINOMA The time interval to recurrence is also significant. Patients with tumor recurrences within 2 years, and especially with recurrences within 3-6 months, have an aggressive tumor and an increased risk of disease progression.