bladder-cancer

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					                                                            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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posted:11/25/2011
language:English
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