Understanding Bladder Cancer: Pathology, Staging, and Management

1. Bladder Cancer Dr. Abdellatif Zayed Amzayed_1919@yahoo.com

2. Pathology: Today Objectives • Predisposing Factors • Pathologic Types • Staging • Grading • spread Management: • Clinical features • Investigations • treatment

3. Predisposing factors: • Industrial toxins • Drugs: e.g. Cyclophosphamide

4. Predisposing factors: • Bilharzial infestation

5. Pathologic Types: • Transitional cell carcinoma: The commonest • Squmous cell carcinoma: In Egypt 50% . • Adinocarcinoma: bladder extrophy • Undifferentiated tumor: Highly aggressive.

6. Layers of the bladder wall

7. Stages • Tis: Carcinoma in situ • Ta: Nan invasive papillary • T1: Invade subepithelial • T2: Invades muscle • T3: Invades perivesical t. • T4: Invades adjacent org.

8. Staging

9. Staging

10. Clinical Features: • Hematuria • Irritative symptoms • Necroturia

11. Investigations • Urine analysis and urine cytology • Ultrasound examination • IVU and CT • Cystoscopy and biopsy

12. Ultrasound Pictures

13. Cystogram DD • Bladder mass • Blood clots • Prostatic enlargement • Fungus ball

14. CT scan • The primary imaging modality in evaluation of bladder tumor.

16. MRI • MRI has higher soft-tissue contrast than CT

20. Ta: Cystoscopic View of Papillary T

21. Tis: Carcinoma in situ

22. Treatment of superficial bladder CA • Complete TUR-T and immediate single intravesical instillation chemotherapy • Adjuvant intravesical immunotherapy:BCG • Radical cystectomy for certain cases.

23. Follow up is essential

24. Treatment of invasive tumor Operable:Radical cystectomy and urine diversion

25. Inoperable:palliative radiotherapy

26. Urine Diversion • Continent: • Orthotopic bladder substitution • Continent reservoir for CIC • Ureterosigmoidostomy • Non Continent: - Uretero- cutaneous diversion - Ileal conduit

27. Orthotopic Neobladder • depends on the intact urethra and sphincter to carry urine to the urethral meatus. • In case the urethra is involved by cancer, a continent reservoir with self catheterizable stoma.

28. Orthotopic Ileal neobladder

29. Ileal orthotopic neobladder Voiding cystourethrogram

30. 3 Dimensions CT (Ilial neobladder)

31. Complications • Hyper continence • Stone • Metabolic acidosis

32. Ureterosigmoidostomy

33. Complications • Ascending infection • Hypercholorimic acidosis • Adenocarcinoma

34. Ilial Conduit

35. 3 D. CT (Ilial Conduit)

36. Complications (1) stomal : • Necrosis • Stenosis • Hernia (2) peristomal: • Fungal dermatitis • Contact dermatitis. • Trauma

37. Uretero Cutaneous Diversions Rarely done because of complications: • Urine leakage. • Infections. • Stenosis.

38. Regarding bladder tumors, all are true except: a. 90% are squamous carcinomas b. Painless haematuria is the commonest presentation c. Cigarette smoking is an important etiological factor d. Superficial tumors are often well controlled by TUR

39. Smoking increases the risk of : • Oro-pharyngeal carcinoma • Lung cancer • Carcinoma of bladder • All of the above

40. Pathology of schistosomiasis may include • ”Swimmers itch” caused by skin penetration by cercariae • Portal hypertension due to fibrosis • Pre-disposition to bladder cancer • All of the above

41. Female Anatomy

42. Male Anatomy

43. Thank you Amzayed_1919@yahoo.com  0101953318