CHAPTER 41 Bladder Cancer
What is the most common kind of bladder cancer?
Transitional cell carcinoma (TCC) accounts for more than 90% of all bladder cancers.
What is the next most common kind of bladder cancer?
Squamous cell carcinoma accounts for 3% to 7%, with adenocarcinoma and metastatic carcinomas uncommon.
What specific agents in cigarette smoke are thought to be the most carcinogenic?
Nitrosamine, 2-naphthylamine, and 4-aminobiphenyl.
Other than smoking, what are other risk factors for bladder cancer?
Analgesic abuse (phenacetin), exposure to chemicals in the workplace such as aniline dye, 2-naphthylamine, paints, oils, gasoline, zinc, and chromium as well as pelvic irradiation, chronic cystitis, and treatment with cyclophosphamide.
Does coffee consumption increase the risk of bladder cancer?
No.
Does the risk of bladder cancer return to baseline after smoking cessation?
Yes, the risk of bladder cancer returns to baseline 20 to 30 years after smoking cessation.
What chromosomal abnormalities are associated with TCC?
Loss segments of chromosome 9, aneuploidy of chromosome 3, 5, 7, 17, defects in p53, p16, p21, p27, Rb, and H-ras.
On which chromosome is the tumor suppressor gene p53 found?
Chromosome 17.
What is the most common presentation of bladder cancer?
Gross, painless hematuria is typical for bladder cancer.
Frequency, urgency, and dysuria are associated with what type of bladder cancer?
Frequency, urgency, and dysuria can be linked to carcinoma in situ (CIS).
What urine markers are available for the evaluation of TCC besides urine cytology?
Protein-based markers include NMP22 and BTA stat/TRAK. NMP22 is a nuclear matrix protein that is elevated in bladder cancer patient and BTA stat/TRAK (qualitative/quantitative) detects complement factor H. Cellular-based markers include ImmunoCyt and UroVysion FISH.
Which method of urinary cytology has the best diagnostic yield: voided or bladder wash?
It has been estimated that the sensitivity of a single barbotage (bladder wash) specimen is equivalent to that of 3 voided specimens (Matzkin et al., 1992).
What is the UroVysion FISH detecting and on which chromosomes?
UroVysion Fluorescence In Situ Hybridization (FISH) detects aneuploidy of chromosomes 3, 7, and 17, as well as the loss of the 9p21 locus.
What is the effect of barbotage (bladder washing) on UroVysion FISH testing?
Bladder washing samples may result in false-positive results on a UroVysion FISH test.
Of patients who have a positive UroVysion FISH with a negative cystoscopy and imaging, how often does this occur and how many will eventually develop a urothelial tumor?
“Anticipatory positive” results (when FISH is positive with negative cystoscopy) occur in up to 30% of screened patients. Approximately two-third of these cases will progress to disease recurrence. The likely explanation is that FISH detects precancerous DNA mutations that promote tumor development in the future (Yoder, 2007).
What percentage of bladder cancer is noninvasive at presentation?
75% of bladder cancer is nonmuscle invasive at presentation, 20% is muscle invasive, and 5% is metastatic.
How often do synchronous upper tract urothelial tumors coexist when a bladder tumor is diagnosed?
2.4% of the time.
If a person has a known upper tract disease, what is the risk of developing a bladder tumor?
30% to 75%.
What are the most predictive factors of disease progression for superficial TCC of the bladder?
Tumor grade, stage, and the presence of CIS are the most significant prognostic factors. Other risk factors include lymphovascular invasion, tumor size, architecture, multifocality, and frequency of prior tumor recurrences.
What tumor parameters are the most predictive factors for lymph node metastasis in invasive TCC of the bladder?
Tumor grade and depth of tumor invasion.
What is the current TNM staging system for cancer of the urinary bladder?
• Ta: Noninvasive papillary carcinoma.
• Tis: Carcinoma in situ.
• T1: Tumor invades lamina propria.
• T2: Tumor invades muscle.
T2a: Superficial muscle (inner half).
T2b: Deep muscle (outer half).
• T3: Tumor invades perivesical fat.
T3a: Microscopic invasion.
T3b: Macroscopic invasion.
• T4: Tumor invades adjacent organs.
T4a: prostate, rectum, uterus, or vagina.
T4b: pelvic or abdominal wall.
What are the main indications for intravesical therapy?
High-grade tumor, low-grade tumor with high risk of recurrence, multiplicity, CIS, and unresectable tumor.
What are the risk factors for systemic side effects from intravesical chemotherapy?
In general, anything that increases drug absorption may lead to systemic toxicity. These factors include low molecular weight of the intravesical agent (thiotepa), extensive area of resection, bladder perforation, persistent gross hematuria, urinary tract infections, and instillation close to the time of resection.
What side effects are common to most forms of intravesical chemotherapy?
Hematuria, cystitis, and irritative voiding symptoms.
Which intravesical agent is most commonly associated with the side effect of myelosuppression?
Thiotepa, because of its low molecular weight, is easily absorbed and can be associated with myelosuppression.
Which intravesical agent is most often associated with the side effect of contact dermatitis?
Mitomycin C is caustic to the skin when direct contact is made.
What are common side effects associated with bacillus Calmette–Guerin (BCG)?
Cystitis, hematuria, fever, sepsis, granulomatous prostatitis, pneumonitis, or hepatitis. Deaths have also been reported from systemic BCGosis.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
