Bladder Cancer

From WikiLectures

Highly differentiated urothelial carcinoma

They currently make up more than 2% of newly diagnosed malignancies.

Epidemiology[edit | edit source]

  • Morbidity is still rising, mortality is decreasing, it affects men 3 times more often ,
  • high incidence - in SW Europe, low in India and Japan,
  • the main occurrence is between the 50s and 70s.

Etiology[edit | edit source]

  • The main risk factor is smoking (mainly black tobacco smoking),
  • exposure to certain industrial pollutants - aromatic amines (benzidine, 2-naphthylamine,…),
  • chronic infection, in endemic areas - schistosomiasis (does mainly squamous cell ca).

Clinical manifestations[edit | edit source]

  • Hematuria and pollakiuria ,
  • increased bladder irritation indicates involvement of the throat, hydronephrosis and secondary pyelonephritis may occur in the area of ​​the urethral orifice ,
  • sometimes it can be completely asymptomatic,
  • general symptoms (anorexia, weight loss, anemia ) - are only in very advanced tumors.

Diagnostics[edit | edit source]

  1. Cystoscopy ,
  2. endoscopic biopsy , or transurethral resection → it is necessary to determine the level.

Histopathology[edit | edit source]

  • 97% are carcinomas from the urothelium , rarely adenocarcinomas and undifferentiated carcinomas , squamous cell carcinomas are endemic (schistosomiasis),
  • macro - different appearance - papillary, infiltrating, probably in ¼ they arise multicentricly (this is the cause of frequent recurrences),
  • they can start as ca in situ and then change into a papillary or infiltrating form,
  • initially the tumor grows in the mucosa, then grows early into the submucosa, muscle and surrounding fat, metastasizes to the pelvic nodes , later paraaortic , more rarely hematogenously.

Therapy[edit | edit source]

The method of therapy depends on a careful evaluation of histology, degree of invasion, extent of the disease.

Surgical treatment[edit | edit source]

  • Non-invasive tumors can be treated by transurethral resection (TUR) - it is a relatively minor damaging procedure, it does not affect bladder function,
  • for the treatment of surface structures - coagulation or laser vaporization ,
  • but often there is a recurrence within 1 year, so the five-year survival does not exceed 80%,
  • therefore, it is recommended to supplement adjuvant intravesical CHT, intravesical application of IFN, BCG vaccine, adriamycin, irradiation,
  • if the tumor grows into the muscle - partial cystectomy ,
    • the rationality of this procedure is questioned given the multifocal origin of urothelial
    • moreover, there is a risk of implantation targets, so it is practically not implemented today,
  • for larger tumors - radical cystectomy with lymphadenectomy , in men with prostatectomy in women with hysterectomy , adnexectomy ,
    • it is a very demanding performance and its indications must be carefully considered.

Radiotherapy[edit | edit source]

  • It is most often not used as an external radiation, as a separate treatment, for numerous emergency services,
  • even as a neoadjuvant , no significant effect has been confirmed,
  • So far, radiochemotherapy (RCHT) could have a good effect, but this is not substantiated by studies
  • however, it is irreplaceable as palliation (skeletal meta analgesia, suppression of hemorrhagic complications).

Chemotherapy[edit | edit source]

  • It is administered either locally or systemically ,
  1. local - in diffuse ca in situ, in superficial tumors after TUR and in papillary (the most advantageous today seems mitomycin C , which is practically not absorbed from the bladder and does not endanger toxicity),
  2. systemic - the main palliative treatment of advanced forms, the tumor responds to a number of cytostatics,
  • corresponds most to - Pt derivatives, anthracyclines, ifosfamide ,
    • adjuvant CHT - very useful especially for nodal involvement,
    • neoadjuvance - has many disadvantages, it is not done by default.

Photodynamic therapy[edit | edit source]

  • It can act in ca in situ and in papillary ca.

Immunotherapy[edit | edit source]

  • Mainly in the form of local application of BCG .

Prognosis[edit | edit source]

  • In non-invasives, 5-year survival is 75-80%.

Links[edit | edit source]

related articles[edit | edit source]

External links[edit | edit source]

Source[edit | edit source]

  • BENEŠ, Jiří. Study materials  [online]. © 2010. [feeling. 16-06-2010]. < http://jirben.wz.cz >.