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Flashcards in Bladder cancer Deck (41):

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)

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


(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)

1. Nuclear grade
2. invade muscle


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

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


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

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


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

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


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

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


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

1. atypical pleiomorphic
2. connective tissue and blood vessels


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

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


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

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


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

1. multifocal


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

1. painless hematuria


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).

1. hesitancy
2. urgency
3. dysuria


(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)

1. Cigarette smoking
2. 2 napthylamine and pelvic irradiation


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

1. Cyclophosphamide


Mutations which are associated with bladder cancer include?

p16, p53 and a loss of chromosome 9


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

1. urine cytology


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

1. cystoscopy
2. areas of thickened mucosa or papillary lesions


intermediate between nonkeratinizing squamous and pseudostratified columnar epithelium

Transitional eptihelium


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

Superficial urothelium (umbrella cell layer)


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

1) Bladder 2) ureter


Relaxed umbrella cells:
- AKA relaxed surface cells
- They are ____ when the bladder is NOT constricted.

domed shape


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



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

High grade; low grade


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

prostate, seminal vesicle;
liver, lung


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

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


flat non-invasive urothelial carcinoma--> precursor is ___.

Such lesions are considered to be _____

carcinoma in situ or CIS; high grade


non-invasive papillary tumors originate from____ which is _____

papillary urothelial hyperplasia; low grade


50% of bladder cancers have no _____



Low grade papillary lesion: circumferential growth around _____

fibrovascular core


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

Flat CIS


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

ureters and urethra;
muscle-invasive cancer


Papillary: fibrovascular core surrounded by
___ and ___

loops and fronds


Invasive Bladder Cancer characterisitics
1, 2, 3

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


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



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

TIS: T in situ


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

1) urine cytology
2) cystoscopy


Urine cytology--> looks at 3 things

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


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

1) mucosal squamous metaplasia
2)squamous carcinoma


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)

9; tumor suppressor
gene p16 (INK4a)


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

inhibitor ; cyclin-dependent kinase; p15


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

Bladder cancer