4% of all cancers
Hematuria: Gross and painless. Occ microscopic.
Frequency, urgency, and dysuria, particularly in patients
with carcinoma in situ of the bladder.
Delayed presentation to urologist.
Microscopic hematuria may be present years before the
detection and may be a predictor of bladder cancer.
Advanced local disease: pelvic pain, bladder outlet
obstruction, or flank pain 2/2 an obstructed upper
Extensive pelvic disease: rectal obstruction,
lymphedema of the extremities, and DVT from
compression of iliac veins.
Outpt cystoscopy for hematuria or irritable voiding
If abnormal, outpt cystoscopy with transurethral
Transitional cell carcinoma:
90% of bladder tumors in U.S.
Dome like structure. Glycolipids. Help to protect from
variations in concentration of urine. Protect from
salt. Unusual shape and thick membrane.
Likely to cause obstruction.
p53 is much identified with this tumor.
1) Aniline dyes, azo dyes and vinyl chloride. Beta-
naphtholene. Concentrated in urinary tract.
2) Cigarette smoking
3) Caffeine, saccharin, phenacitin.
4) Rubber production.
5) Schistosomiasis in Egypt. Much incidence.
Papillary variants: Graded by degree of nuclear
enlargement/hyperchromasia. Low grade tumors
Non-papillary variants: Grading similar to papillary
tumors except no grade I
Clinical state: most important prognostic factor
Transurethral rescection, cystectomy
Radiotherapy also plays role.