Bladder cancer is any of several types of cancer arising from the epithelial lining (i.e., the urothelium) of the urinary bladder.

1. By : Fikri Abdullah Zawawi

2.  Name : Vesela Emilie
 Gender : Female
 Age : 61 years old
 Address : Bohuslavice
 Date of admission : 02/04/2017
 Weight : 78kg Height : 160cm BMI : 30.47
 Reason of admission : Planned TURB (03/04/17)

3.  Examined by Dr. Skotak in February 2017 due to
repeated attack of macrohematuria without pain.
 Treated for UTI by GP, however intermittent
hematuria continue referred to urologist.

4.  SLE
 Hypertension
 Operation : Hysterectomy (20 years ago)
 Laparoscopy : Cholecystectomy ( 10 years ago)
 Grandmother – stomach problem & lymphoma
 Grandfather – bone TB
 Mother - healthy
 Father – liver disease

5.  Prestarium combi ( a diuretic)
 Afiten (ca channel blocker)
 Retired
 Married , 3 children
 Smoking (10 cig/day)
 Alcohol occasionally

6.  Ultrasound : Kidneys- without any pathologic finding
Bladder- suspect of tumor formation on
left side with size 3x2x3 cm
 Cystoscopy : there is exophytic formation near the left
ureter opening, the orifice is covered by the tumor

7.  CT : native CT & with contrast application, 2D
reconstruction = tumor formation size about 14x14x11
mm at the left ureter orifice.
left ureter with normal width, after contrast
application without pathologic and defect finding.
right ureter is normal.
kidney pelvis without dilatation, kidneys are normal,
adrenal glands are normal, liver with reduced density
at steatosis area, pancreas is normal.
there is no enlargement of lymph node around the big
vessels.
numerous diverticulum around the sigmoid colon

8.  Patient admitted in the urology department on
02.04.17 and underwent TURB on 03.04.17.
 Surgery is done without complication(however due to
deep resection of tumor no mitomycin application)
after that patient is monitored in the intermediate care
room and later transferred to standard ward.
 Overall patient in good condition and can be sent
home

9.  Epidemiology : 99% primary, 1% secondary
 2nd most common cancer in genitourinary tract.
 Average age of diagnosis= 65 years
 Because it is lined by urothelium, its neoplasm is nearly
always transitional cell carcinomas (70-75% is
superficial)
 During prolonged infections or irritation, it can
undergoes metaplasia into squamous or glandular
epithelium squamous cell carcinoma /
adenocarcinoma

10.  Etiology :
 Smoking ( polycyclic amines which are secreted into
urine of smokers)
 Occupational exposure (carcinogens)
 X-ray radiation
 Drugs : cyclosphosphamide, fenacitine
 Schistomiasis
 Family history

11.  Staging : TNM staging

12. Bladder Cancer
Primay Secondary
Epithelial
Mesenchymal Secondary cancer is sometimes seen
from direct
invasion from a primary tumour in
the colon,
rectum or uterus.
Rhabdomyosarcoma
(children)
Transitional
carcinoma
Squamous cell
carcinoma
adenocarcinoma

13.  Symptoms :
 Hematuria (micro/macro)
 Painless ( pain if the cancer has invaded outside the
bladder
 Frequency, urgency, stranguria
 Sterile pyuria
 Investigations :
 Kidney and bladder ultrasound
 Cytoscopy and biopsy
 CT scan ( for staging )

14.  Carcinoma in situ = BCG and must be kept under close
surveillance because very easily turns into invasive
cancer
 Superficial cancer (Ta and T1) = TURB + adjuvant
intravesical instillation of Mitomycin C.
regular follow-up.
 Invasive cancer (T2 and T3) =
 Radiotherapy : curative / palliative
 Chemotherapy :
 MVAC= methotrexate, vinblastine, doxorubicin, cisplatin
 MVEC= epirubicin instead of doxorubicin
 Radical cystectomy (RACE)

15.  Incontinent external diversion :
 Nephrostomy
 Uereterostomy
 Ureterileostomy ( Bricker’s conduit)
 Continent orthotopic neobladder : Studer Operation