Bladder Cancer

Dr_Omar AlTarhuni
M.D urologist

UROEPITHELIAL TUMORS
INCIDENCE
URINARY BLADDER
(94% OF ALL UROEPITHELIAL TUMORS)

RENAL PELVIS

(5% OF ALL UROTHELIAL TUMORS)

URETER
(1% OF ALL UROTHELIAL TUMORS)

Bladder Cancer

The second most common cancer of the

genitourinary system (most common in China)
The male-female is 2.7:1
The peak incidence is in persons from 50-70 years
4th common in males & 8th in females

Etiology
Industrial toxins
Cigarette smoking
Genetic events
Other risk factors
cyclophosphamide, alkylating agents,
radiotherapy of pelvis.

Family history

Pathology
Histopathlogy
1.transitional cell carcinoma 90%
2.squamous cell carcinoma 7-8%
3.adenocarcinoma
1-2%
4.other types

Grading
Grade 1
Grade 2
Grage 3

mild anaplasia
moderate anaplasia
marked anaplasia

TRANSITIONAL CELL CARCINOMA

PAPILLARY TYPE

80%

50% ARE INFILTRATIVE MALIGNANCIES

NONPAPILLARY TYPE 20%

ALL CONSIDERED TO BE MALIGNANT

PAPILLARY CARCINOMA
INVASIVE VERSUS NONINVASIVE

NONPAPILLARY (FLAT) CARCINOMA

INVASIVE VERSUS NONINVASIVE

Clinical Findings
A. Symptoms:
Painless Hematuria 85~90%
Macroscopic up to 25% risk of TCC
Microscopic up to 5% risk of TCC

Irritative voiding symptoms

B. Signs:
The majority of patients have no pertinent physical signs.

Clinical Findings
C. Lab tests:
Urine testhematuria
Urinary cytologydepend on grade and volume
of the tumor , it is more sensitive in high grade
tumours or carcinoma in situ .
markers: BTA, NMP22, telomerase

Clinical Findings
D. Imaging:
Ultrasonographyscreen
IVUevaluation of upper urinary tract
CT/MRIassessment of the depth of infiltration
and pelvic LN enlargement
E. Cystoscopy

Diagnosis
Upper tract imaging US / IVU
Cystoscopy and resection / biopsy
Urine cytology
Bloods
CT etc

Diagnosis
Ultrasonography can be used as screening method to detect
bladder tumors and upper urinary tract obstruction.
both CT and MRI are used to characterize the extent of
bladder wall invasion and detect enlarged pelvic lymph node.

Cystoscopy

Cystoscopy
the diagnosis of bladder cancer depends on cystoscopy.
cystoscopy can provide good information on the extent of the
tumour.
All visible tumour removed and muscle under it resected plus
multiple biopsies taken of suspicious sites.

Cystoscopy of bladder Ca

Radiology
Excretory urography: In every case, to examine the upper
urinary tracts for associated urothelial tumours, to rule
out ureteral obstruction and other upper tract
abnormalities .
CT scans: Tumour extent, nodal metastasis and distant
spread (Accuracy in nodal mets- 40-70%)
MRI: Same resolution, better sensitivity
Chest X-Ray: Routine
Bone scan: in symptomatic patients

Plain X.ray
? calcifications in bladder wall eg Bilharziasis
or calcified bladder tumor .

CT SCAN & MRI

-calcifications
-Hydronephrosis or uretronehrosis
-extravasical extension of the tumor .
-Aid in staging of the tumor

Ultrasonography of Bladder Ca (Arrow

Head)

IVU of Bladder Tumor

CT scan of bladder Ca

TNM Tumor Staging

Bladder Cancer

TNM Tumor Staging

SQUAMOUS CARCINOMA
9%

SQUAMOUS TUMORS
ASSOCIATED WITH INFECTION AND STONES, LEUKOPLAKIA
SQUAMOUS METAPLASIA OF TRANSITIONAL EPITHELIUM
MOST ARE SOLITARY
CAN BE PAPILLARY OR SESSILE
HIGHLY INVASIVE
OVERALL, POOR PROGNOSIS

SQUAMOUS TUMORS
DIFFICULT TO RECOGNIZE DUE TO UNDERLYING DISEASE
INFECTION
STONES

OFTEN INVASIVE OR METASTATIC AT TIME OF DIAGNOSIS

PREDOMINENTLY EXTRALUMINAL
MAY APPEAR AS URETERAL STRICTURE

URETEROPELVIC FILLING DEFECT

D.D. OF A FILLING DEFECT

COLLECTING SYSTEM OR URETER

STONE
BLOOD CLOT
NEOPLASM
GAS BUBBLE
CROSSING VESSEL
PERISTALSIS
PYELITIS / URETERITIS CYSTICA
INFECTION / NECROTIC DEBRIS
FUNGUS BALL
LEUKOPLAKIA, MALAKOPLAKIA
SLOUGHED PAPILLA, ABERRANT PAPILLA

Treatment
(A) Superficial bladder cancer (Ta,T1,Tis)
transurethral resection
intravesical chemotherapy or immnotherapy(BCG)
cystoscopic surveillance

Treatment
(B) Invasive bladder cancer (T2-T4)
partial cyctectomy
solitary, inflitrating tumors localized along the posterior lateral wall
or dome of the bladder.
radical cystectomy
1.muscle-invasive bladder cancer T2-T4a, N0-NX, M0.
2.high-risk superficial tumours (T1G3, BCG-resistant Tis)
3.extensive papillary disease
Urinary diversion after radical cystectomy

Bladder Cancer

partial cyctectomy

Radical Cystectomy

Metastatic
Radiotherapy
Modern 3D-radiotherapy is a reasonable treatment option in
patients who wish to preserve their bladder

Chemothery
chemothery for metastatic disease.
adjuvant chemotherapy
Neoadjuvant chemotherapy

Urothelial cancer

8% of malign. Kidney tumors

Age - 60-70 y.o.
male:female

2:1

Symptoms

painless hematuria
Pain in the back
Disuria
Colic pain (rare)
non-specific late symptoms
-appetite loss
weight loss
fatigue

Diagnostics
US
IVP
Retrograde
ureteropyelography
Cytology
Uretero-renoscopy
CT/ MRI

IVP

Retrograde

Treatment

Nephrureterectomy
Laser coagulation

Chemotherapy

Operative
Adjuvant

Treatment

Kidney
Ureter

Part of the bladder

removing