Bladder cancer

Question 1

Because invasion of the (1) layer of the bladder greatly affects the prognosis and survival rate of bladder cancer, it is not surprising that (2) lesions can have a worse prognosis than (3) lesions which are exophytic growths within the (4)

Answer 1

1. muscle
2. flat carcinoma-in-situ
3. papillary
4. bladder lumen

Question 2

(1) is an important predictor of bladder cancer prognosis because only about 10% of low grade cancers (2) whereas nearly 80% of high grade ones (2)

Answer 2

1. Nuclear grade

2. invade muscle

Question 3

Invasive bladder cancers can invade local structures like (1) and tend to spread to (2) before metastasizing to (3)

Answer 3

1. prostate, seminal vesicle and ureter
2. regional lymph nodes
3. liver, lungs or bone marrow

Question 4

Flat transitional cell carcinomas often present as (1). They can be (2) and extensive.

Answer 4

1. reddish areas of bladder wall thickening without a clear mass
2. multifocal

Question 5

The precursor for invasive flat transitional cell carcinomas are (1) which is usually high nuclear grade

Answer 5

1. transitional cell carcinoma-in-situ (CIS)

Question 6

Papillary transitional cell carcinomas of the bladder may develop from (1) and often become (2) lesions which can extend into the (3)

Answer 6

1. papillary urothelial hyperplasia
2. exophytic
3. bladder lumen

Question 7

Like at other sites, papillary carcinoma within the bladder consists of (1) cells which surround a central core which contains (2).

Answer 7

1. atypical pleiomorphic

2. connective tissue and blood vessels

Question 8

(1) can be extensive and give a cauliflower like appearance to the tumors grossly

Answer 8

1. Papillary fronds of papillary transitional cell carcinomas of the bladder

Question 9

Invasive bladder cancer is usually (1), although worldwide about 10% is (2), associated with (3) which causes a premalignant (4) metaplasia

Answer 9

1. transitional epithelium
2. squamous cell carcinoma
3. schistosomiasis mansoni
4. squamous

Question 10

Unlike other sites in the body (except skin) where cancers are usually single, bladder cancer can occur at multiple sites at the same time, so it is (1) in nature

Answer 10

1. multifocal

Question 11

Classically, bladder cancers present with (1) which can either be visible to the patient or physician or only present by microscopic exam

Answer 11

1. painless hematuria

Question 12

If the cancer enlarges, it can lead to urethral obstruction which would present as (1) (inability to begin urine flow) or (2) (a sudden feeling that you need to urinate ) or (3) (painful urination).

Answer 12

1. hesitancy
2. urgency
3. dysuria

Question 13

(1) is an important risk factor for bladder cancer and some occupational or environmental exposures are associated with the development of bladder cancer including (2)

Answer 13

1. Cigarette smoking

2. 2 napthylamine and pelvic irradiation

Question 14

(1) can cause a hemorrhagic cystitis (inflammation of the bladder) which is associated with an increased risk of bladder cancer

Answer 14

1. Cyclophosphamide

Question 15

Mutations which are associated with bladder cancer include?

Answer 15

p16, p53 and a loss of chromosome 9

Question 16

One approach to screening symptomatic patients for bladder cancer is (1) in which malignant cells are identified because of their nuclear changes and increased nuclear to cytoplasmic ratio

Answer 16

1. urine cytology

Question 17

If a patient has malignant cells identified by urine cytology, then (1) (transurethral endoscopy of the bladder) can be performed and (2) can be biopsied

Answer 17

1. cystoscopy

2. areas of thickened mucosa or papillary lesions

Question 18

intermediate between nonkeratinizing squamous and pseudostratified columnar epithelium

Answer 18

Transitional eptihelium

Question 19

1) is single layer of umbrella cells, which are large and elliptical with abundant eosinophilic cytoplasm and often binucleation or prominent nucleoli

Answer 19

Superficial urothelium (umbrella cell layer)

Question 20

Muscularis layer very prominent in the 1) and very thin in the 2)

Answer 20

1) Bladder 2) ureter

Question 21

Relaxed umbrella cells:

• AKA relaxed surface cells
• They are ____ when the bladder is NOT constricted.

Answer 21

domed shape

Question 22

____ invasion of bladder–> 30% 5-year survival;

Answer 22

muscularis

Question 23

Grade is important:

(a) ___ papillary carcinomas: 80% will invade
(b) ____ papillary carcinoma: 10% will invade over time.

Answer 23

High grade; low grade

Question 24

When bladder cancer spreads, they can spread to surrounding structures: ___ and ____; they can spread upwards into the ureter or into the retroperitoneal space. They can also spread to regional lymph nodes first then to ____, _____ and even bone marrow

Answer 24

prostate, seminal vesicle;

liver, lung

Question 25

Flat non-invasive urothelial carcinoma develops as a ____ | Papillary tumors develop as _____

Answer 25

HIGH grade and then invades; | LOW grade, then go to HIGH grade then invade

Question 26

flat non-invasive urothelial carcinoma--> precursor is ___. Such lesions are considered to be _____

Answer 26

carcinoma in situ or CIS; high grade

Question 27

non-invasive papillary tumors originate from____ which is _____

Answer 27

papillary urothelial hyperplasia; low grade

Question 28

50% of bladder cancers have no _____

Answer 28

precursor

Question 29

Low grade papillary lesion: circumferential growth around _____

Answer 29

fibrovascular core

Question 30

Grossly: mucosal reddening, granularity, or thickening without mass.

Answer 30

Flat CIS

Question 31

Multifocal, may involve most of the bladder,extend to ____ | If untreated, 50% to 75% of CIS cases progress to ____ (High)

Answer 31

ureters and urethra; | muscle-invasive cancer

Question 32

Papillary: fibrovascular core surrounded by | ___ and ___

Answer 32

loops and fronds

Question 33

Invasive Bladder Cancer characterisitics | 1, 2, 3

Answer 33

1. Invasion 2. Fungating 3. Necrosis (yellow amorphous)

Question 34

this is unusual for cancer, since most cancers tend to be single, whereas bladder cancer are ___

Answer 34

multifocal

Question 35

Bladder cancers are staged using the TNM: tumor size, nodes, metastasis. ___invades into the muscularis propria, at which it becomes a lot more life-threatening. ____ means hasn't invaded into the lamina propria yet. ___ through the wall into other tissues

Answer 35

T3; TIS: T in situ T4

Question 36

1) is a good screening tool to see if any changes present, and if they are can do 2) and biopsy

Answer 36

1) urine cytology | 2) cystoscopy

Question 37

Urine cytology--> looks at 3 things

Answer 37

Pleiomorphism, Nuclear:cytoplasm ratio, nuclear changes (clearing and nucleoli)

Question 38

``` Schistosoma haematobium infections (Egypt, Sudan) ova produce chronic inflammatory response that induces progressive 1) which then develops into 2) ```

Answer 38

1) mucosal squamous metaplasia | 2) squamous carcinoma

Question 39

1. Bladder cancers frequently have chromosome___deletions where ___ was located; this gene encodes an inhibitor of a cyclin-dependent kinase or the related tumor suppressor gene p15 2. Also p53 mutations (prevent apoptosis)

Answer 39

``` 9; tumor suppressor gene p16 (INK4a) ```

Question 40

tumor suppressor gene p16 (INK4a) encodes an____of a _____ or the related tumor suppressor gene ____

Answer 40

inhibitor ; cyclin-dependent kinase; p15

Question 41

1. higher in men 3:1 2. developed nations 3. urban dwellers. 4. 80% age 50-80

Answer 41

Bladder cancer