Cancer of the bladder by MikeJenny

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									Cancer of the bladder



                        1
Aetiology and incidence
• More common in people between 50 and 70.

• 90% transitional cell carcinoma

• Squamous cell carcinoma

• Main cause cigarette smoking

• Cancers of prostate, colon, rectum and female
  genital organs may metastasize to bladder
                                                  2
Clinical Manifestations
• Usually arise at the base; involve ureteral
  orifices and bladder neck.
• Painless haematuria – most common
  symptom
• Infection – common complication
• Frequency
• Urgency
• Dysuria
• Back pain may occur with metastasis
                                                3
Assessment and diagnostic findings
• Cystocopy
• Excretory urography
• CT scan
• USGM
• Biopsy
• Cytologic examination of the wahings of the
  bladder.
• Newer diagnostic indicators are being studied :
• Bladder tumour antigens
    Nuclear matrix proteins
    Adhesion molecules
    Cytoskeletal proteins
    Growth factors
    Molecular assay                                 4
Risk Factors for Bladder Cancer
  • Cigarette smoking; risk proportional to number
    of packets
  • Environmental carcinogens, dyes, rubber,
    leather ink or paint
  • Recurrent or chronic bacterial infection of the
    urinary tract
  • Bladder stones
  • High urinary pH
  • High cholesterol intake
  • Pelvic radiation therapy
  • Cancers arising from the prostate, colon, rectum
    in males                                         5
Treatment

Standard therapies for bladder cancer include

• Surgery

• radiation therapy

• Chemotherapy

• Immunotherapy

• biological therapy.
                                                6
Medical Management
    Consider :
•   The grade of the cancer (the degree of
    cellular differentiation)
•   The stage of the tumour growth(the
    degree of local invasion and the presence
    or absence of metastasis)
•   The multicentricity (having many centers)
    of the tumour
•   The patient’s age, and physical, mental
    and emotional status
                                                7
  Pharmacologic therapy


• Combination of methotrexate, 5-fluorouracil,
  vinblastine, doxorubicin (adriamycin),
  cyclophosphamide

• Gemcitabine and the taxanes – promising
  improvement

• Topical therapy – instillation into the bladder of
  thiotepa, doxorubicin,mitomycin, ethoglucid and
                                                  8
  BCG
  Surgical Management
• Transurethral resection or fulguration for simple
  papillomas
• After these procedures which spare the bladder
  intravesical administration of BCG is the treatment
  of choice
• Simple cystectomy – for invasive or multifocal
  bladder cancers
• Radical cystectomy – which involve near by
  structures
• Transurethral resection of the tumour + radiation +
  chemotherapy
                                                  9
10
Radiation Therapy

• Preoperatively – to reduce microextension
  of the nepoplasm and viability of tumour
  cells

• Done also in combination with surgery

• For inoperable tumour


                                          11
12
• Hydrostatic therapy with balloon filled with
  water – pressure necrosis

• Instillation of formalin, phenol, or silver
  nitrate relieves haematuria and stranguary
  in some patients



                                             13
       Investigational Therapy

• Photodynamic techniques –
  haematoporphyrin – a photosensitizing
  agent – injected – cancer cells pick up –
  laser light – haematoporphyrin converted
  into toxic medication




                                              14
Multicentric
 tumours




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