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Bladder mass clinical features & staging
The document outlines the clinical features and staging of urinary bladder carcinoma, highlighting hematuria as a common symptom and the importance of staging for treatment options and prognosis. It details the various stages of the disease, grading of tumors according to WHO guidelines, and the high recurrence rate of bladder cancer, emphasizing risk factors for recurrence and disease progression. Additionally, it covers metastasis patterns and unusual sites for transitional cell carcinoma (TCC).
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Bladder mass clinical features & staging
- 1. CARCINOMA URINARY BLADDER CLINICALFEATURES & STAGING By Dr. Muhammad Saifullah Post-Graduate Resident (FINAL YEAR) Department of Urology & Renal Transplantation Allied Hospital, Faisalabad.
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- 4. HEMATURIA Hematuria is thepresenting symptom in 85–90% of patients Gross or microscopic Intermittent rather than constant
- 5. IRRITATIVE SYMPTOMS •Vesical irritability •Frequency •Urgency •Dysuria Irritativevoiding 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 notmuscle invasive!
- 9. WHY STAGING THE DISEASESIS NECESSARY?
- 10. 1. TREATMENT OPTIONS 2.PROGNOSIS
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- 12. PAPILLARY VS FLATGROWTHS
- 13. STAGING PRIMARY TUMOUR •Tx….. Primarytumour cannot be assessed •To….. No evidence of primary tumour •Tis….. Carcinoma in situ: ‘flat tumour’
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- 15. STAGING PRIMARY TUMOUR •Ta….. Non-invasivepapillary carcinoma
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- 17. STAGING PRIMARY TUMOUR •T1….. Tumourinvades subepithelial connective tissue
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- 19. STAGING T2….. Tumour invadesmuscle •T2a….. Tumour invades superficial muscle (inner half) •T2b….. Tumour invades deep muscle (outer half)
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- 21. STAGING T3….. Tumour invadesperivesical tissue •T3a….. Microscopically •T3b….. Macroscopically (extravesical mass)
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- 23. STAGING T4….. Tumour invadesany 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….. Metastasisin 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 inmultiple lymph nodes in the true pelvis (hypogastric, obturator, external iliac, or presacral) •N3….. Metastasis in common iliac lymph node(s)
- 32. STAGING M - Distantmetastasis •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 theheart, kidney, spleen, pancreas, and reproductive system.
- 35. STAGE OF BLADDERCANCER AT PRESENTATION
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- 37. GRADING….. WHO GRADINGIN 1973 •Urothelial papilloma •Grade 1: well differentiated •Grade 2: moderately differentiated •Grade 3: poorly differentiated
- 38. GRADING….. WHO GRADINGIN 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 IN1973 VS 2004
- 40. WHO GRADING IN1973 VS 2004
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- 43. RECURRENT BLADDER CARCINOMA • Bladdercancer 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 factorsfor 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 timeinterval 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.