Bladder cancer Notes

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This Osmosis High-Yield Note provides an overview of Bladder cancer essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Bladder cancer:

Non-urothelial bladder cancers

Transitional cell carcinoma

NOTES NOTES BLADDER CANCER GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Cellular cancers in bladder lining/wall TYPES ▪ Non-urothelial ▪ Transitional cell carcinoma (AKA urothelial) RISK FACTORS ▪ Irritants, carcinogens (e.g. smoking) DIAGNOSIS LAB RESULTS ▪ Cystoscopy-guided biopsy (definitive diagnosis) TREATMENT ▪ See individual disorders; depends on tumor stage, grade, location; kidney condition; localized/regional/metastatic SIGNS & SYMPTOMS ▪ Hematuria, pain NON-UROTHELIAL BLADDER CANCERS osms.it/non-urothelial-bladder PATHOLOGY & CAUSES ▪ Bladder cancers that do not arise from the urothelium ▪ More invasive, poorer prognosis; may arise from urothelial layer but cells differentiate ▪ Squamous cell metaplasia: cells of urothelium → pancake-like appearance of squamous cells → differentiate into squamous cell carcinoma ▫ Grow in multiple locations ▫ Cause extensive keratinization ▫ Caused by chronic irritation (e.g. recurrent urinary tract infections, long- 776 OSMOSIS.ORG standing kidney stones, infection with Schistosoma haematobium, a type of flatworm) ▪ Primary adenocarcinomas ▫ Frequently metastasize ▫ Derive from glandular tissue → produce a lot of mucin ▫ Primary form of bladder tumor associated with bladder exstrophy ▫ Can develop as complication of Schistosoma haematobium infection ▪ Adenocarcinomas of urachus ▫ Similar to bladder adenocarcinomas ▫ Arises from urachus (fibrous tissue
Chapter 108 Bladder Cancer sitting at dome of bladder) RISK FACTORS ▪ Chronic urinary tract infections (UTIs) COMPLICATIONS DIAGNOSIS LAB RESULTS ▪ Cystoscopic biopsy ▫ Definitive diagnosis based on cellular morphology ▪ Metastasis SIGNS & SYMPTOMS ▪ Bladder irritation ▪ Pain (location determined by tumor size/ extent—flank, suprapubic, perineal, abdominal, etc.) ▪ Hematuria ▪ Adenocarcinomas secrete mucin → mucusuria ▪ Urachal adenocarcinomas → abdominal mass TREATMENT SURGERY ▪ Transurethral resection, small tumors resected with cystoscope ▪ Radical cystectomy, complete bladder removal, dissection of surrounding lymph nodes ▪ Urachal adenocarcinomas → remove dome of bladder, urachal ligament, umbilicus Figure 108.1 Histological appearance of Schistosoma haematobia eggs in a bladder biopsy. OSMOSIS.ORG 777
Figure 108.2 Illustration of a cytoscopy being performed. A tissue sample will be collected and tested to determine if the tumor is the result of a squamous cell carcinoma or an adenocarcinoma. TRANSITIONAL CELL CARCINOMA osms.it/transitional-cell-carcinoma PATHOLOGY & CAUSES ▪ Most common form of lower urinary tract cancer (bladder, urethra) ▪ AKA urothelial cell carcinoma ▪ Can also affect upper urinary tract (e.g. renal pelvis, ureter) ▪ Usually due to bladder urothelium ▪ Mutations in tumour suppressor protein p53 → horizontally growing, flat tumours (invasive) ▫ p53 independent mutations → outward facing finger-like projections (noninvasive, less aggressive) ▪ Tumours often multifocal ▫ Field effect: entire urothelial field exposed to carcinogens, all cells bathed in urine ▫ Implantation theory: tumour cells detach from one site, implant at another 778 OSMOSIS.ORG RISK FACTORS ▪ Advanced age, heavy alcohol use, human papillomavirus (HPV) infection, more common in individuals who are biologically male, chronic extended dwell times (not voiding bladder for long periods) COMPLICATIONS ▪ Metastasis MNEMONIC: P-SAC Risk factors: exposure to carcinogens Phenacetin: banned analgesic, once common Smoking: primary risk factor Aniline: compound used in rubber/dye manufacturing Cyclophosphamide: cytotoxic medicine, cancer/autoimmune conditions
Chapter 108 Bladder Cancer TREATMENT SIGNS & SYMPTOMS ▪ Hematuria (typically intermittent, painless, present throughout urination) ▪ Pain (location determined by size/extent of tumor: flank, suprapubic, perineal, abdominal, etc.) ▪ Constitutional symptoms (severe disease) ▪ Dysuria; frequent/urgent urination DIAGNOSIS DIAGNOSTIC IMAGING Cystoscopy LAB RESULTS ▪ Depends on tumor stage, grade, location; kidney condition; localized/regional/ metastatic MEDICATIONS Chemotherapy ▪ Non-aggressive: localised via catheter ▪ Aggressive: systemic SURGERY ▪ Non-aggressive: transurethral resection via cystoscopy (localized, non-invasive tumors) ▪ Aggressive: complete removal of prostate, bladder (cystoprostatectomy) ▪ Identify presence of blood in urine ▪ Cystoscopy-guided biopsy of tumour (definitive diagnosis) Figure 108.3 Histological appearance of muscle-invasive transitional cell carcinoma of the bladder. OSMOSIS.ORG 779
Figure 108.4 An MRI scan in the axial plane demonstrating a transitional cell carcinoma of the bladder. Figure 108.5 Transitional cell carcinoma can occur anywhere from the renal pelvis to the distal urethra. This coronal CT scan demonstrated a transitional cell carcinoma of the mid ureter. Figure 108.6 Immunohistochemical staining with compound CK20 demonstrating urothelial carcinoma in situ. The urothelium has undergone malignant transformation but has not yet begun to invade surrounding tissue. 780 OSMOSIS.ORG

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Bladder cancer essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Bladder cancer by visiting the associated Learn Page.