Bladder carcinoma

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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 50 and 70 years.

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 (mainly squamous cell carcinoma).

Clinical manifestations[edit | edit source]

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

Diagnosis[edit | edit source]

  1. Cystoscopy,
  2. endoscopic biopsy, eventually transurethral resection → this is necessary to determine the progress

Histopathology[edit | edit source]

  • 97% are urothelial carcinomas, rarely adenocarcinomas and undifferentiated carcinomas, squamous cell carcinoma is endemic (schistosomiasis),
  • macro - different appearance - papillary, infiltrating, probably in 1/4 they arise multicentricly (this is the cause of frequent recurrences),
  • they can start as ca in situ and then change to a papillary or infiltrating form,
  • initially the tumor grows in the mucosa, early into the submucosa, muscle and surrounding fat, metastasizes to the pelvic nodes, later paraaortic, more rarely hematogenously.

Treatment[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 with transurethral resection (TUR) - it is relatively non-intrusive, it does not affect bladder function,
  • for the treatment of surface structures - coagulation or laser vaporization,
  • often, however, recurrence occurs 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 muscle - partial cystectomy is determined,
    • the rationality of this procedure is questioned due to the multifocal origin of urothelial tumor
    • in addition, there is a risk of implantation metastases, so it is practically not performed today,
  • for larger tumors - "radical cystectomy with lymphadenectomy", in men with prostatectomy, in women with hysterectomy, adnexectomy,
    • it is a very demanding procedure and its indications must be carefully considered.

Radiotherapy[edit | edit source]

  • Most often as external irradiation, it is not used as a separate treatment, for numerous emergency services,
  • even as neoadjuvance no significant effect has been confirmed,
  • so far radiochemotherapy (RCHT) could have a good effect, but this is not based on studies,
  • however, it is irreplaceable as palliation (skeletal meta analgesia, suppression of hemorrhagic complications).

Chemotherapy[edit | edit source]

  • Served either locally or systemically,
  1. local - in diffuse in situ carcinomas, in superficial tumors after TUR and in papillary carcinomas (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 advanced forms, the tumor responds to a number of cytostatics,
  • most similar 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]

  • This can work in "in situ" carcinomas and in papillary carcinomas.

Immunotherapy[edit | edit source]

  • Mainly in the form of local application of BCG.

Prognosis[edit | edit source]

  • For non-invasive form, 5-year survival is 75-80%.


Links[edit | edit source]

Related links[edit | edit source]

External links[edit | edit source]

uroonkologie, onemocnění retroperitonea, onemocnění dolních cest močových

Source[edit | edit source]

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