Please enable JavaScript.
Coggle requires JavaScript to display documents.
REGUB Surgery - Bladder Cancer (ii) (CIS (cystoscopy (no consistent or…
REGUB Surgery - Bladder Cancer (ii)
Staging
superficial non-muscle invasive: 70%, excellent prognosis with prompt tam 10-15% of high grade progress to invasive
muscle invasive: 20%, subject to local invasion + mets (50% have occult mets)
flat non-invasive CIS: 10%
Poor prognostic features in superficial bladder cancer
multiple initial tumours twice as likely to recur
over 3cm - 60% recurrence
solid broad based tumours likely to recur
G3
submucosal invasion
vasc invasion (70% met rate)
CIS: 82% recur, 73% progress to invasion
Tx
primary lesion
TURBT (transurethral resection of bladder tumour) - removes lesion using rectoscope, provides histology
surveillance: if superficial + low grade
if invasive/high grade
radial cystoprostatetomy + urinary diversion
ileal conduit (incontinent diversion to skin)
ileal orthoropic neobladder (continent diversion to urethra)
neoadjuvant chemo
radiation
mets
palliative care
radiotherapy: for primary tumour + bony mets
chemo
Prognosis of invasive/high grade
confined: 50% 5 yr survival
nodes or local spread: 15% 5 yr survival
distant mets: 0% 5yr survival
CIS
not precancerous, frank malignancy
@ presentation
25% asymp
75% have irritative voiding symptoms
75% have microscopic haematuria
cytology: 90-100% +ve
cystoscopy
no consistent or specific features
bladder may appear normal
sometimes patchy velvety lesions
bx therefore essential
do CT to see beyond the mucosa
variable natural hx
diffuse type: majority, most become muscle invasive
localised type: only a minority of these become muscle invasive
Tx
intravesical chemo with BCG
minor reactions common
fever occurs in 3%, required anti-TB drugs
granulomatous prostatitis occurs in 0.9%
BCG sepsis: intravasc absorption of lethal dose, 20% mortality, tx with steroids + anti-TB medications
radical cystoprostatectomy if chemo fails
SCC
5-7%
develop without prior hx
rapidly growing aggressive tumours
present as solitary, invasive + high stage
risk factors
bladder diverticular (congenital or acquired)
chronic indwelling catheters (chronic irritation)
schisto (55-70%, a/w more favourable prognosis)
bladder stones
chronic UTI
stasis (stones, BPH, neuropathic baller in DM)
Adenocarc
2%
6th-7th decade, x2 in men
typically solitary - trigonal or tracheal
commonest tumour in exstrophy (congenital abnormality, skin one lower abdo wall doesn't form properly, bladder open + exposed)
signet cell type infiltrative diffusely
make sure its not a CR primary
Rarely in bladder: lymphoma, sarcoma, mets