This document discusses transitional cell carcinoma of the bladder. It notes that 90% of bladder cancers are transitional cell carcinoma, while 5% are squamous cell carcinoma and 1% are adenocarcinoma. It covers causes, staging according to the TNM system, types of bladder tumors, behavior, symptoms, investigations, and treatments which include transurethral resection of the bladder tumor (TURBT) for non-muscle invasive tumors and radical cystectomy for muscle-invasive tumors. Recurrence rates are higher for carcinoma in situ, high grade tumors, and those with a high chance of recurrence, so intravesical BCG may be used after TURBT for these cases.

2. TRANSITIONAL CELL CANCER
90%
SQUAMOUS CANCER
5%
ADENOCARCINOMA
1%

3.  CAUSES
 STAGING
 TYPES OF BLADDER TUMOUR
 BEHAVIOUR
 SYMPTOMS
 INVESTIGATIONS
 TREATMENT

4.  Chemical Carcinogens
Aniline dyes ,Aromatic amines
 CIGARETTE SMOKING - 60% of cases
 Cyclophosphamide
 Pelvic Irradiation
 Oncogenes
 Coffee and Tea Drinking
 Analgesic Abuse (phenacitin)
 Artificial Sweeteners
 Chronic Cystitis and Other Infections

6. 2-naphthylamine, 4-aminobiphenyl, 4-nitrobiphenyl,
4-4-diaminobiphenyl (benzidine), and
2-amino-1-naphthol
 rubber and textile industries
 autoworker,
 painter,
 truck driver,
 leather worker,
 metal worker,
 dry cleaner,
 paper manufacturer,
 dental technician,
 barber or beautician,

7.  ▪ Bladder cancer is nearly three times more
common in men than in women,
 ▪ Bladder cancer is rare in persons younger
than the age of 50, with median ages at
diagnosis of around 70 years for each
gender.
 ▪ Bladder cancer is almost never found
incidentally at autopsy,

8.  ▪ Inactivation of several tumor suppressor
genes is important in the development and
progression of bladder cancer.
 ▪ The important tumor suppressor genes
associated with bladder cancer include TP53 and
cell cycle inhibitors RB, P21, P27, and P16.
 ▪ Oncogenes associated with bladder cancer is
RAS, a membrane-bound, mitogenic, signal
transduction molecule.
 ▪ Overexpression of normal genes including
those for the receptor of EGF (ERBB1) and ERBB2
occur in most bladder cancers and facilitate
cancer development and progression

9.  TNM STAGING
 NON MUSCLE INVASIVE
 MUSCLE INVASIVE

11. AJCC-UICC, TNM Staging
Ta
Papillary, epithelium confined
Tis
Flat carcinoma in situ
T1
Lamina propria invasion
T2a
Superficial muscularis propria
invasion
T2b
Deep muscularis propria
invasion
T3a
Microscopic extension into
perivesical fat
T3b
Macroscopic extension into
perivesical fat
T4a
Cancer invading pelvic viscera
(e.g., prostatic stroma, vaginal
wall, rectum, uterus)
T4b
Extension to pelvic sidewalls,
abdominal walls, or bony pelvis

12. N0 No histologic pelvic node
metastases
N1 Single positive node ≤2 cm in
diameter, below common iliacs
N2 Single positive node 2-5 cm in
greatest diameter or multiple
positive nodes
N3 Positive nodes >5 cm in diameter
Nx Nodal status unknown
M0 No distant metastases
M1 Distant metastases documented
Mx
Distant metastases status uncertain

13.  NON MUSCLE INVASIVE 70%
 Ta
 T1
 MUSCLE INVASIVE 25%
 CARCINOMA IN SITU 05%
 GRADE I, II, III

14.  Single or Multiple
 Papillary
 Pedunculated
 Surrounding mucosa
 Recurrences
 Progression

15. • Multiple
• Large
• T1 tumours
• Associated Carcinoma in situ
• High grade

16. • Solid
• Large
• Broad based
• Surrounding mucosa
• INVASION
• METASTASIS

17. • Male / Female 3 : 1
• PAINLESS GROSS HAEMATURIA
• CLOTS AND CLOT RETENTION
• IRRITATIVE VOIDING
• PAIN
• SYMPTOMS OF METASTASIS (LATE)

18.  ULTRASOUND
 INTRAVENOUS UROGRAM
 CT SCAN
 CYSTOSCOPY
 URINE CYTOLOGY
 ROUTINE INVESTIGATIONS

22.  SUPERFICIAL BLADDER TUMOURS
TURBT
BASE BIOPSY
 CHECK CYSTOSCOPY
 INTRAVESICAL BCG IF NEEDED

24. AFTER TURBT
INDICATIONS
CARCINOMA IN SITU
HIGH CHANCE OF RECURRENCE

25. • RADICAL CYSTECTOMY
Removal of
Bladder
Prostate
Lower Ureters
Pelvic Nodes
• Uterus and Vagina

26.  Partial cystectomy
 Radiation
 Chemotherapy Radiation
 Radiation and Chemotherapy also used in
Advanced cases

27.  Painless Haematuria
 Cystoscopy, TURBT
 SUPERFICIAL TURBT
Followup
Intra vesical BCG
 INVASIVE Radical Cystectomy