dr. abdellatif zayed [email protected] bladder cancer
TRANSCRIPT
Predisposing FactorsPredisposing FactorsPathologic TypesPathologic TypesStagingStagingGradingGradingspreadspread
PathologPathology:y:
Management:Management: •Clinical featuresClinical features•InvestigationsInvestigations•treatmenttreatment
Today Objectives
Predisposing factors:Predisposing factors:
1.1. Industrial toxins Industrial toxins
2.2. Drugs: e.g. Drugs: e.g. CyclophosphamidCyclophosphamidee
Predisposing factors:Predisposing factors:
Bilharzial infestationBilharzial infestation
1.1. Transitional cell carcinoma: The commonest Transitional cell carcinoma: The commonest
2.2. Squmous cell carcinoma: In Egypt Squmous cell carcinoma: In Egypt 50%50% . .
3.3. Adinocarcinoma: bladder extrophyAdinocarcinoma: bladder extrophy
4.4. Undifferentiated tumor: Highly aggressive.Undifferentiated tumor: Highly aggressive.
Pathologic Types:Pathologic Types:
Layers of the bladder wallLayers of the bladder wall
Tis: Carcinoma in situTis: Carcinoma in situ Ta: Nan invasive Ta: Nan invasive
papillary papillary T1: Invade subepithelialT1: Invade subepithelial T2: Invades muscleT2: Invades muscle T3: Invades perivesical t.T3: Invades perivesical t. T4: Invades adjacent T4: Invades adjacent
org.org.
StagesStages
Tis: Carcinoma in situTis: Carcinoma in situ
Ta: Nan invas. Ta: Nan invas. papillary papillary
T1: Invade T1: Invade subepithelialsubepithelial
T2: Invade muscleT2: Invade muscle
T3: Invade perivesical T3: Invade perivesical t.t.
T4: Invade adjacent T4: Invade adjacent org.org.
StagingStaging
StagingStaging
Clinical Features:Clinical Features:
HematuriaHematuria
Irritative Irritative symptoms symptoms
NecroturiaNecroturia
Urine analysis and urine Urine analysis and urine cytologycytology
Ultrasound examinationUltrasound examination
IVU and CT IVU and CT
Cystoscopy and biopsyCystoscopy and biopsy
InvestigationsInvestigations
Ultrasound Ultrasound PicturesPictures
CystogramCystogram
DDDD Bladder massBladder mass Blood clotsBlood clots Prostatic Prostatic
enlargementenlargement Fungus ballFungus ball
The primary The primary imaging imaging modality in modality in evaluation of evaluation of bladder tumor.bladder tumor.
CT scanCT scan
MRI MRI has higher soft-tissue has higher soft-tissue contrast than CTcontrast than CT
MRIMRI
Ta: Cystoscopic View of Ta: Cystoscopic View of Papillary TPapillary T
Tis: Carcinoma in situTis: Carcinoma in situ
Treatment of superficial bladder Treatment of superficial bladder CACA
Complete TUR-T and immediate single Complete TUR-T and immediate single intravesical instillation chemotherapyintravesical instillation chemotherapy
Adjuvant intravesical immunotherapy:Adjuvant intravesical immunotherapy: BCGBCG
Radical cystectomy for certain cases.Radical cystectomy for certain cases.
Follow up is essentialFollow up is essential
Operable:Operable: Radical cystectomy Radical cystectomy and urine diversionand urine diversion
Treatment of invasive tumorTreatment of invasive tumor
Inoperable:Inoperable: palliative palliative radiotherapyradiotherapy
Continent:Continent:– Orthotopic bladder Orthotopic bladder
substitutionsubstitution– Continent reservoir for CICContinent reservoir for CIC– UreterosigmoidostomyUreterosigmoidostomy
Non Continent:Non Continent:
- - Uretero- cutaneous diversionUretero- cutaneous diversion
- Ileal conduit- Ileal conduit
Urine Urine DiversionDiversion
depends on the intact urethra depends on the intact urethra and sphincter to carry urine to and sphincter to carry urine to the urethral meatus. the urethral meatus.
In case the urethra is involved In case the urethra is involved by cancer, a continent by cancer, a continent reservoir with self reservoir with self catheterizable stomacatheterizable stoma..
Orthotopic NeobladderOrthotopic Neobladder
Orthotopic Ileal Orthotopic Ileal neobladderneobladder
Ileal orthotopic neobladderIleal orthotopic neobladder
Voiding Voiding cystourethrogramcystourethrogram
3 Dimensions CT (Ilial 3 Dimensions CT (Ilial neobladder)neobladder)
Hyper continenceHyper continence
Stone Stone
Metabolic acidosisMetabolic acidosis
ComplicationComplicationss
UreterosigmoidostomyUreterosigmoidostomy
Ascending infectionAscending infection
Hypercholorimic acidosisHypercholorimic acidosis
AdenocarcinomaAdenocarcinoma
ComplicationsComplications
Ilial ConduitIlial Conduit
3 D. CT (Ilial Conduit)3 D. CT (Ilial Conduit)
(1) stomal : (1) stomal : Necrosis Necrosis Stenosis Stenosis HerniaHernia
(2) peristomal: (2) peristomal: Fungal dermatitisFungal dermatitis Contact dermatitis.Contact dermatitis. TraumaTrauma
ComplicatioComplicationsns
Rarely done because of Rarely done because of complications:complications:
Urine leakage. Urine leakage. Infections.Infections. Stenosis.Stenosis.
Uretero Cutaneous DiversionsUretero Cutaneous Diversions
Regarding bladder tumors, all Regarding bladder tumors, all are true except:are true except:
a. 90% are squamous carcinomasa. 90% are squamous carcinomas
b. Painless haematuria is the b. Painless haematuria is the commonest presentationcommonest presentation
c. Cigarette smoking is an c. Cigarette smoking is an important etiological factorimportant etiological factor
d. Superficial tumors are often well d. Superficial tumors are often well controlled by TURcontrolled by TUR
Smoking increases the risk Smoking increases the risk
of :of :
a.a. Oro-pharyngeal carcinoma Oro-pharyngeal carcinoma
b.b. Lung cancer Lung cancer
c.c. Carcinoma of bladder Carcinoma of bladder
d.d. All of the aboveAll of the above
Pathology of schistosomiasis may Pathology of schistosomiasis may includeinclude
a.a. ””Swimmers itch” caused by skin Swimmers itch” caused by skin penetration by cercariaepenetration by cercariae
b.b. Portal hypertension due to Portal hypertension due to fibrosis fibrosis
c.c. Pre-disposition to bladder cancerPre-disposition to bladder cancer
d.d. All of the aboveAll of the above
Female AnatomyFemale Anatomy
Male AnatomyMale Anatomy
