urology bladder ca

1. BLADDER CANCER
1
By
Haneen Ayad Jawad
Module : Urinary system
alnahrain College of medicine

2. Objectives :-
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 To define bladder cancer
 To list risk factors & pathogenesis of bladder
cancer
 To know the signs & symptoms of bladder
cancer
 How can we diagnosis & staging bladder
cancer
 To know the types of bladder cancer
 The treatment and prevention of bladder
cancer

3. Introduction
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The urinary bladder is a muscular organ that
collects and stores urine from the kidneys
before disposal by uriation, that sits on the
pelvic floor. Bladder cancer is any of several
types of cancer arising from the tissues of the
urinary bladder. It is a disease in which cells
grow abnormally and have the potential to
spread to other parts of the body.

4. Introduction
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Bladder cancer is the second most common
cancer of the genitourinary tract. The average
age at diagnosis is 65 years. At that time,
approximately 75% of bladder cancers are
localized to the bladder; 25% have spread to
regional lymph nodes or distant sites.

5. RISK FACTORS &
PATHOGENESIS
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 Cigarette smoking
 Occupational exposure , e.g Workers in the chemical.
 Patients who have received cyclophosphamide for the management
of various malignant diseases.
 Physical trauma to the urothelium induced by infection and
instrumentation increases the risk of malignancy.
 The exact genetic events leading to the development of bladder
cancer are unknown, but they are likely to be multiple and may
involve : The activation of oncogenes like Chromosome 11p.
 Diet: People whose diets include large amounts of fried meats and
animal fats are thought to be at higher risk of bladder cancer. Not
drinking enough fluids, especially water, each day may increase the
risk of bladder cancer

6. Signs and symptoms
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 Hematuria is the presenting symptom in 85–90%
of patients with bladder cancer.
 In a smaller percentage of patients, it is
accompanied by symptoms of vesical irritability:
frequency, urgency, and dysuria.
 Symptoms of advanced disease include bone pain
from bone metastases or flank pain from
retroperitoneal metastases or ureteral obstruction.
 Patients with large-volume or invasive tumors may
be found to have bladder wall thickening or a
palpable mass—findings that may be detected on
a careful bimanual examination under anesthesia.

7. LABORATORY FINDING & DIAGNOSIS
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1-Routine testing: The most common
laboratory abnormality is hematuria.
2-Urinary cytology: Exfoliated cells from both
normal and neoplastic urothelium can be
readily identified in voided urine.Detection
rates are high for tumors of high grade and s
stage but not as impressive for low grade
superficial tumors.

8. LABORATORY FINDING &
DIAGNOSIS
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3-Other markers: Several new tests have been developed in order to
overcome the short comings of urinary cytology such as the low
sensitivity for low-grade superficial tumors :
 BTA ( bladder tumor antigen )
 NMP22 (nuclear matrix protein 22 )
 Lewis X antigen
 Telomerase
4-CT scan: This is similar to an X-ray film but shows much greater
detail. It gives a three-dimensional view of your bladder, the rest of
your urinary tract (especially the kidneys), and your pelvis to look for
masses and other abnormalities.

9. LABORATORY FINDING &
DIAGNOSIS
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5-MRI (magnetic resonance imaging): is also an
alternative test to look at the kidneys, ureters, and
bladder in individuals with contrast (dye) allergies.
6-Ultrasound: This is similar to the technique used to look
at a fetus in a pregnant woman's uterus. In this painless
test, a handheld device run over the surface of the skin
uses sound waves to examine the contours of the
bladder and other structures in the pelvis. This can show
the size of a tumor and may show if it has spread to
other organs.

10. STAGING
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Currently, the most commonly used staging
system allows for a precise and simultaneous
description of the primary tumor stage (T
stage), the status of lymph nodes (N stage),
and metastatic sites (M stage).

11. The TNM staging system for
bladder cancer is as follows:
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12. Types of Bladder Cancer
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1-Transitional cell carcinoma : this type accounts for
about 90 percent of bladder cancers. There are two
subtypes of TCC:
 Papillary carcinoma: This type of TCC grows out from
the inner surface of the bladder toward the hollow
center in fingerlike projections. Often, these tumors
are called “noninvasive papillary cancers,” meaning
they don’t grow into the deeper layers of the bladder
wall.
 Flat carcinomas: This type of TCC does not grow out
of the urothelium toward the center of the bladder.
Rather, flat carcinomas remain on the surface of the
bladder wall. If a flat carcinoma is confined to the
urothelium, it is called “noninvasive flat carcinoma” or
“flat carcinoma in situ.”

13. Types of Bladder Cancer
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2-Squamous cell carcinoma: accounts for between 5% and
10% of all bladder cancers, often associated here with a
history of chronic infection or chronic catheter use Squamous
cells look similar to the flat cells on the surface of the skin.
Almost all squamous cell carcinomas of the bladder are
invasive.
3-Adenocarcinoma: of the bladder closely resembles the gland-
forming cells seen in colon cancers, and accounts for
about <2% of all bladder cancers.
4-Undifferentiated carcinomas: which are rare (accounting for
<2%), have no mature epithelial elements. Very
undifferentiated tumors with neuroendocrine features and
small cell carcinomas tend to be aggressive and present with
metastases.
5-Mixed carcinoma: 6% of all bladder cancers and are
composed of a combination of transitional, glandular,
squamous, or undifferentiated patterns.

14. Treatment
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A.INTRAVESICAL CHEMOTHERAPY
 Mitomycin C is an antitumor, antibiotic, alkylating agent that inhibits
DNA synthesis.
 BCG is an attenuated strain of Mycobacterium bovis. The exact
mechanism by which BCG exerts its antitumor effect is unknown, but it
seems to be immunologically mediated.
B. SURGERY
1-Transurethral resection(TRU):is the initial form of treatment for all
bladder cancers. It allows a reasonably accurate estimate of tumor
stage and grade.

15. Treatment
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2-implies removal of the anterior pelvic organs: in men, the bladder
with its surrounding fat and peritoneal attachments, the prostate, and
the seminal vesicles; in women, the bladder and surrounding fat and
peritoneal attachments, cervix, uterus, anterior vaginal vault, urethra,
and ovaries. This remains the “gold standard” of treatment for
patients with muscle invasive bladder cancer.
3-Partial cystectomy : is rarely indicated in the management of
patients with invasive bladder cancer.
C. RADIOTHERAPY :External beam irradiation (5000–7000 cGy),
delivered in fractions over a 5- to 8-week period .
D. CHEMOTHERAPY :The single most active agent is cisplatin , Other
effective agents include methotrexate, doxorubicin,
cyclophosphamide and 5-fluorouracil .

16. Prevention
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 If you smoke, quit. However, the risk of bladder
cancer does not diminish.
 Avoid unsafe exposures to chemicals in the
workplace. If your work involves chemicals, make sure
you are protected.
 Drinking plenty of fluids may dilute any cancer-
causing substances in the bladder and may help flush
them out before they can cause damage (for example
drinking water at least 1,5 L per day)
 Eat Fruit and yellow-orange vegetables, particularly
carrots and those containing selenium,are probably
associated with a moderately reduced risk of bladder
cancer.

17. Summary
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Bladder cancer is the second most common cancer
of the genitourinary tract.Its main causes is
Cigarette smoking, Occupational exposure like
chemical and sometimes genetic(rare) Hematuria
is the presenting symptom in 85–90% of
patients.Bladder cancer has many types and 90%
of bladder cancers are transitional cell
carcinoma.It can be treated by intravesical
chemotherapy,surgery,radiotherapy or
chemotherapy.It could be prevent by quit smoking
,avoid unsafe exposures to chemicals and
drinking a lot of water per day .

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