Cancer of the bladder

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Cancer of the bladder
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Aetiology and incidence

• More common in people between 50 and 70.
• 90 transitional cell carcinoma
• Squamous cell carcinoma
• Main cause cigarette smoking
• Cancers of prostate, colon, rectum and female
  genital organs may metastasize to bladder

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Clinical Manifestations

• Usually arise at the base involve ureteral
  orifices and bladder neck.
• Painless haematuria most common symptom
• Infection common complication
• Frequency
• Urgency
• Dysuria
• Back pain may occur with metastasis

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Assessment and diagnostic findings

• Cystocopy
• Excretory urography
• CT scan
• USGM
• Biopsy
• Cytologic examination of the wahings of the
  bladder.
• Newer diagnostic indicators are being studied
• Bladder tumour antigens
• Nuclear matrix proteins
• Adhesion molecules
• Cytoskeletal proteins
• Growth factors
• Molecular assay

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Risk Factors for Bladder Cancer

• Cigarette smoking risk proportional to number of
  packets
• Environmental carcinogens, dyes, rubber, leather
  ink or paint
• Recurrent or chronic bacterial infection of the
  urinary tract
• Bladder stones
• High urinary pH
• High cholesterol intake
• Pelvic radiation therapy
• Cancers arising from the prostate, colon, rectum
  in males

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Treatment

• Standard therapies for bladder cancer include
• Surgery
• radiation therapy
• Chemotherapy
• Immunotherapy
• biological therapy.

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Medical Management

• Consider
• The grade of the cancer (the degree of cellular
  differentiation)
• The stage of the tumour growth(the degree of
  local invasion and the presence or absence of
  metastasis)
• The multicentricity (having many centers) of the
  tumour
• The patients age, and physical, mental and
  emotional status

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Pharmacologic therapy

• Combination of methotrexate, 5-fluorouracil,
  vinblastine, doxorubicin (adriamycin),
  cyclophosphamide
• Gemcitabine and the taxanes promising
  improvement
• Topical therapy instillation into the bladder
  of thiotepa, doxorubicin,mitomycin, ethoglucid
  and BCG

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Surgical Management

• Transurethral resection or fulguration for simple
  papillomas
• After these procedures which spare the bladder
  intravesical administration of BCG is the
  treatment of choice
• Simple cystectomy for invasive or multifocal
  bladder cancers
• Radical cystectomy which involve near by
  structures
• Transurethral resection of the tumour radiation
  chemotherapy

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Radiation Therapy

• Preoperatively to reduce microextension of the
  nepoplasm and viability of tumour cells
• Done also in combination with surgery
• For inoperable tumour

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• Hydrostatic therapy with balloon filled with
  water pressure necrosis
• Instillation of formalin, phenol, or silver
  nitrate relieves haematuria and stranguary in
  some patients

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Investigational Therapy

• Photodynamic techniques haematoporphyrin a
  photosensitizing agent injected cancer cells
  pick up laser light haematoporphyrin
  converted into toxic medication

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Multicentric tumours
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