8.7 Bladder, Ureteric And Urethral Cancer

Question 1

Bladder cancer
RF

Answer 1

• older people
• incurable

RF
- smoking

Question 2

Histological types of bladder cancer:

Answer 2

1. Urothelial (epithelium)
2. Squamous cell carcinoma
3. Adenocarcinoma

Question 3

Causes of Urothelial Carcinoma

Answer 3

• smoking (⬆️smoke; ⬆️risk)
• industrial carcinogens (aromatic amines)
• drugs (phenacetin, cylophosphamide)
• pelvic irradiation

Question 4

What does grade and stage of baldder ca mean?

Answer 4

Grade
- degree of differentiation
- how “bad” do cells look under microscope
- indicates aggressiveness
- low grade / high grade
- *Carcinoma in sito(cis) always high grade in bladder ca

Stage
- how far cancer has grown
- T-stage - local growth
- N-stage - spread to lymph nodes
- M-stage - metastasis

Question 5

Difference between superficial vs infiltrating Bladder ca?

Answer 5

T1 - no muscle invasive ca (superficial)
T2 and higher - muscle invasive

Question 6

Explain Field defect

Answer 6

• entire urothelium is prone to malignant change, exposed to similar carcinogen
• 50-70% of superficial tumours will recur after intial removal
• 10-20% of superficial tumours will recur and become invasive after initial removal

Question 7

Low grade vs. High garde carcinomas

Answer 7

Low grade
- no aggressive
- does not grown into bladder wall (detrusor muscle)

High grade
- aggressive
- invades into bladder wall (detrusor muscle)
Spreads:
- local to prostate, pelvic side wall muscles, uterus and vagina
- lymph nodes
- haematogenous (after ln involvement)

Question 8

Causes of Bladder squamous cell ca

Answer 8

Chronic irritation
- bilharzia
- bladder stones
- recurrent UTI
- permanent indwelling catheter (>10 years)

Question 9

Causes of *Bladder adeno ca**

Answer 9

Sec from other organs
- prostate
- colon
- rectum

Prim seldom
- urachus carcinoma
- bladder exstrophy

Question 10

Ureteric / upper tract cancer histological types:
Also know as TCC/ transitional cells carcinoma

Answer 10

Renal pelvis and calyses:
- 90% urothelial ca
- 10% squamous cell ca

Ureter
- >99% urothelial ca

Question 11

Ureteric / Upper tract ca risk factors

Answer 11

Urothelial ca
- smoking
- industrial carcinogens
-Lynch syn
- balkan nephropathy
- analgesic abuse

Squamous ca
- calculi

Question 12

Urethral cancer

Answer 12

• rare in males

Three areas
1. Proximal third - transitional cells (urothelial ca)
2. Distal two-thirds - squamous epithelium (scc)
3. Periurethral glands - columnar epithelium (adeno ca)

Question 13

Urethral cancer histological types

Answer 13

• Squamous cell carcinoma
• transitional cell ca (urothelial)
• adenoca
• undifferentiated tumours and sarcoma
• melanoma

Question 14

Urethra cancer spread

Answer 14

Very aggressive

Local invasion
- vagina
- bladder
- symphysis pubis

Lymphatic
- distal: inguinal
- proximal: iliac

Haematogenous
- lung metastases