Bladder Carcinomas

Bladder Carcinomas

Bladder carcinomas

• Bladder cancer is the most common neoplasm of the upper urinary tract and the 7th most common cancer worldwide.
• It is most often diagnosed in males over 60 years old.
• Signs and symptoms include hematuria, dysuria, and burning while urinating.
• We also need to watch for urinary tract obstructions that can lead to hydronephrosis and infection.
• Diagnosis: We can use cystoscopy, imaging, and biopsy to diagnose bladder cancer.
• Treatments depend on how invasive the cancer is:
  • If there is no muscularis invasion, we can use endoscopic resection intravesical therapy.
  • If the muscularis has been invaded, we need to perform cystectomy, possibly with chemotherapy.
• Unfortunately, bladder cancer commonly reoccurs.
• We need to watch for metastasis, particularly to the lymph nodes, lungs, liver, and bone.
• Urothelial cell carcinoma is the most common form of bladder cancer (formerly called transitional cell carcinoma), which accounts for approximately 90% of all bladder cancers.
  • This form of cancer can affect any of the structures lined by urothelial cells: the urethra, bladder, ureters, and renal pelvis;
  • The mucosal layer lines these structures and comprises transitional cells and lamina propria; carcinoma originates in the transitional cells.
  • Lesions can be papillary or flat, and start out in the mucosa, but can invade deeper tissues.
• Key risk factors include smoking, exposure to paint, petroleum, and certain dyes; urothelial cell carcinoma is also associated with Lynch syndrome (aka hereditary nonpolyposis colorectal cancer).
• Squamous cell bladder carcinoma is less common than urothelial cell cancer; in these patients, chronic bladder irritation or infection triggers transitional cell transformation to squamous cells.
  • A key risk factor is infection with schistosomiasis.