CARCINOMA OF URINARY BLADDER

• More common in whites, higher social- economic status.
• 75% tumours are localised to bladder
• 25% spread to regional nodes

CLASSIFICATION-

I) According to histologically-

a) Transitional cell carcinoma (90%)

b) Squamous cell carcinoma

c) Adenocarcinoma

d) Mixed

e) Undifferentiated

ETIOLOGY-

1. Transitional cell carcinoma

• Cigratte smoking (MC)
• Chemical carcinogens- naphthylamine benzidine, aniline, acrolein, hydrocarbons (BHAAM)
• Schistosomiasis
• Drugs- phenacetin, chlornaphazine, cyclophosphamide, analgesic
• Pelvic irradiation
• Occupation- rubber, leather etc

    2. Squamous cell carcinoma

• Schistosomiasis
• Chronic UTI
• Bladder diverticula

    3. Adenocarcinoma (5%)

• Urahal remnants
• Ectopia vesicae
• Occurs in intestinal urinary conduits, augmentation, pouches and ureterosigmoidotomies

FEATURES-

1. Transitional Cell carcinoma

• MC type of bladder tumour
• MC appears as papillary or exophytic lesions
• Carcinoma in situ or flat urotheal carcinoma
• Pagetoid spread
• Sites- lateral wall (MC), trigone

     2. Squamous Cell carcinoma-

• Arise from lateral bladder wall and dome
• Nodular and invasive

     3. Adenocarcinoma

• 3 types- primary vesical, urchal, metastatic
• Primary adenocarcinoma arise along the floor
• Adenocarcinoma arising from urachus occurs at the dome.

PATHOLOGY-

• MC type grossly in Papillary
• MC type histologically Transitional cell carcinoma

CLINICAL FEATURES-

• Most tumours develop at trigone and adjacent posterolateral wall with urethral involvement
• Tumour tend to be multifocal in bladder

STAGING-

INVESTIGATIONS-

1. Cystoscopy (gold standard investigations)-

• Cystoscopy and transurethral resection (TUR) is for diagnosis
• Detecting cancer in symptomatic patient and assessing response to treatment
• Most useful for early diagnosis of recurrence in TCC

     2. IVP-

• Filling defect in bladder, dilatation of ureter

     3. Ultrasound-

• It is useful investigation which can detect a bladder carcinoma
• Can detect liver metastases

     4. CT scan is IOC for staging

     5. Bimanual palpation-

• Rectoabdominally in males
• Vaginoabdominally in females

     6. New tests-

• Detection of antigens such as nuclear matrix proteins (NMP22) or mini chromosome maintence (MCM) in urine
• Detect new or recurrent tumours

TREATMENT-

1. Stage Tis, Ta, T1

• Transurethral resection of tumour (Ta)
• Chemotherapy- thiotepa (MC- BCG)/ adriamycin/ mitomycin
• BCG or interferon immunotherapy (Tis)
• T1- TUR + BCG + chemotherapy

    2. T2- T4 lesion

• Radical cystectomy followed by chemotherapy
• Neoadjuvant chemotherapy followed by Radical cystectomy

    3. Any T, N1, M0 or any T, N0, M1

• Systemic chemotherapy

    4. Small lesions

• Partial cystectomy