ONCOLOGY—1 BLADDER CANCER 4% of all cancers Presentation: 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 tract. Extensive pelvic disease: rectal obstruction, lymphedema of the extremities, and DVT from compression of iliac veins. Diagnosis: Outpt cystoscopy for hematuria or irritable voiding symptoms. If abnormal, outpt cystoscopy with transurethral resection. 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. Epidemiology 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. Endemic. Papillary variants: Graded by degree of nuclear enlargement/hyperchromasia. Low grade tumors usually non-invasive Non-papillary variants: Grading similar to papillary tumors except no grade I Clinical state: most important prognostic factor Treatment: Transurethral rescection, cystectomy Radiotherapy also plays role.
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