h of bladder cancer

Question 1

variants in bladder mucosa in males and femalse

Answer 1

• M 61 F 39
• Brunns nests 53 36
• Cystitis glandularis 32 28
• Squamous metaplasia 3 19
• none 6 1
• Squamous metaplasia ketatinising type not seen
• Glandular metaplasia colonic type not seen

Question 2

bladder tumours (who classifcation) - benign

Answer 2

• Benign
– Transitional cell papilloma
– Inverted papilloma
– Squamous papilloma
– Villous adenoma
• Papillary urothelial tumour (papilloma)
• Note change of terminology:
– Urothelial not transitional cell

Question 3

bladder tumours malignant

Answer 3

• Malignant
– Papillary urothelial carcinoma
– Infiltrating urothelial cell carcinoma
– Urothelial carcinoma in situ
– Variants of urothelial carcinoma

• Squamous cell carcinoma
• Adenocarcinoma
• Spindle/ sarcomatoid

– Small cell
– others
– connective tissue Lymphoma 2o tumours

Question 4

classifcation and origin

Answer 4

• Urachal—– TCC, Adenocarcinoma, squamous
• Urothelial
• Papillary
• CIS
• Squamous metaplasia- Squamous cancer
• Glandular metaplasia- Adenocarcinoma
• Others– connective tissue & Lymphoma

• TB and congenital abnormalities
– Glandular metaplasia
– Ademocarcinoma

• Schisosoma stones, diverticulae
– Squamous metaplasia
– Squamous carcinoma

Question 5

riskf actors

Answer 5

• Analine dyes: 2 napthyalamine (occupational)
– Hair dyes
• Smoking
• Phenacetin
• Cyclophosphamide

Question 6

pathways to invasice bladder cancer

Answer 6

either

norm -> papillary tumour -> invasive g2/g3

or

norm -> CIS -> Invasive G2/g3

Question 7

moolecular biological evience

Answer 7

P53 mutations
0 / 10 Papillary tumours
20/ 31 invasive
Olumi
1 / 36 Papillary tumours
25/ 49 invasive
15/ 23 CIS
Spruck

Question 8

TCC stagin UICC

Answer 8

TNM system
Ta non invasive
Tcis Flat carcinoma in situ
T1 Lamina propria invasion
T2a superficial muscle invasion
T2b deep muscle invasion (>50)
T3a Microscopic extravesical spread
T3b Extravesical Mass
T4a Into prostate/ uterus or vagina
T4b Pelvic wall/ abdominal wall

Question 9

papillary tumours

Answer 9

Grade 0- papilloma
Grade 1- epithelium is thickened
Grade 2-cytological atypia
prognosis 50% recur
increased risk if tumours are multiple or if there has
been a previous recurrence
recurrences are usually of the same stage and
grade as the previous tumour
some may progress to invasion

Question 10

invasive blader tumours

Answer 10

Macroscopic appearances:
sessile, ulcerated, +- papillary
component

Microscopic
G2-mild to moderate cytological atypia
G3-severe cytological atypia+- poor
differentiation

Question 11

outcome

Answer 11

• Local invasion to surrounding organs: often renal
failure.
• Metastasis to regional LNs
• Haematogenous spread- lungs, bone, liver.

Question 12

carcinoma in situ

Answer 12

• Malignant cystitis
• Patches associated with other tumours
• Spread: ureters; urethra; prostatic ducts
• Risk of invasion