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![Management
• Non–muscle-invasive bladder cancer
carcinoma in situ [CIS]
– -transurethral resection of bladder tumor
(TURBT) with postoperative dose of
intravesical chemotherapy and periodic
cystoscopy.
• Muscle-invasive -
– Radical cystoprostatectomy in men
– Radical cystectomy with anterior pelvic
exenteration in women
• Bilateral pelvic lymphadenectomy (PLND),
standard or extended](https://image.slidesharecdn.com/ca-221122054740-10ffa971/75/Ca-Bladder-pptx-74-2048.jpg)
Uploaded byPradeep Pande
Ca. Bladder.pptx
This document provides tips for using a PowerPoint presentation (PPT) as an active learning tool. Some key points: - Blank slides are included between content slides to allow time for student discussion of what they already know about each topic. - The presenter should first show a blank slide, ask students for their input, then show the next slide with content. - This process of blank slide + discussion, then content slide, is repeated for each topic and can be done through multiple revisions for deeper learning. - It can be used for self-study by displaying a blank slide, thinking about what you know, then reading the next content slide.
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Ca. Bladder.pptx
- 1. Tips on usingmy ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. Good for self study also. Display blank slide> Think what you already know about this > Read next slide.
- 2.
- 3. Learning Objectives 1. Introduction& History 2. Relevant Anatomy, Physiology 3. Aetiology 4. Pathophysiology 5. Pathology 6. Classification 7. Clinical Features 8. Investigations 9. Management 10. Prevention 11. Guidelines 12. Take home messages
- 4.
- 5. Introduction & History. •Bladder cancer is a common urologic cancer that has the highest recurrence rate of any malignancy. • The most common type is urothelial carcinoma (UC). • Other types squamous cell and adenocarcinomas.
- 6.
- 7. Relevant Anatomy • Arisesin urothelium- transitional epithelium. • It lines urinary ducts • Multilayered- – renal calyxes (2 cell layers), – ureters (3 to 5 cell layers), – urethra (4 to 5 cell layers) – and urinary bladder (up to 6 cell layers).
- 8. Relevant Anatomy • Thebladder is lined by epithelial cells that are somewhere in between the thick layers of squamous cells and the single layer of tall cells of glandular epithelia. Logically, these cells are called transitional cells because they represent a transition between these two disparate epithelial cell types.
- 9.
- 10. Aetiology • Idiopathic • Congenital/Genetic • Nutritional Deficiency/excess • Traumatic • Infections /Infestation • Autoimmune • Neoplastic (Benign/Malignant) • Degenerative / lifestyle • Iatrogenic • Psychosomatic • Poisoning/ Toxins/ Drug induced
- 11. Aetiology • Idiopathic • Congenital/Genetic • Nutritional Deficiency/excess • Traumatic • Infections /Infestation • Autoimmune • Neoplastic (Benign/Malignant) • Degenerative / lifestyle • Iatrogenic • Psychosomatic • Poisoning/ Toxins/ Drug induced
- 12. Aetiology of Aetiology •Idiopathic • Congenital/ Genetic • Nutritional Deficiency/excess • Traumatic • Infections /Infestation • Autoimmune • Neoplastic (Benign/Malignant) • Degenerative / lifestyle • Iatrogenic • Psychosomatic • Poisoning/ Toxins/ Drug induced
- 13.
- 14. Risk Factors • Upto 80% of bladder cancer cases are associated with environmental exposure. • Upto 50% bladder cancer is due to smoking. • Tobacco smoking nitrosamine, 2-naphthylamine, and 4-aminobiphenyl are possible carcinogenic agents found in cigarette smoke.. • Workers exposed to aromatic amines , polycyclic aromatic hydrocarbons and heavy metals.
- 15. Risk Factors who workwith organic chemicals and dyes: • Beauticians • Dry cleaners • Painters • Paper production workers • Rope-and-twine industry workers • Dental workers • Physicians • Barbers
- 16. Risk Factors • Peopleliving in urban areas are also more likely to develop bladder cancer. • Arsenic exposure • Radiation treatment of the pelvis • Chemotherapy with cyclophosphamide
- 17. Risk Factors forSCC • Long-term indwelling catheters - A 16- to 20-fold increase in the risk of developing SCC • Schistosoma haematobium infection • Bladder diverticula • BCG treatment for CIS has been reported to lead to development of SCC. • Bladder exstrophy • Urachal remnants
- 18. Risk Factors • Noconvincing evidence exists for a hereditary factor • Coffee consumption does not increase the risk of developing bladder cancer. • Artificial sweeteners (eg, saccharin, cyclamate) and bladder cancer;
- 19.
- 20. Pathophysiology • Urothelial carcinoma(UC) initiates by carcinogens excreted in urine. • SCC – Chronic irritation.
- 21. Pathophysiology • Bladder canceris often described as a polyclonal field change defect with frequent recurrences due to a heightened potential for malignant transformation. • Urothelial carcinoma (UC) arises from stem cells that are adjacent to the basement membrane of the epithelial surface.
- 22. Pathophysiology Important early molecularevents- – somatic mutations in- • Fibroblast growth receptor3 (FGFR-3) noninvasive • Tumor protein p53 (TP53) and invasive pathways – Loss of heterozygosity (LOH) on chromosome 9.
- 23.
- 24. Pathology • The mostcommon type is urothelial carcinoma (UC). • Other types squamous cell and adenocarcinomas. • Growth patterns: – Papillary (70%) – Sessile – Mixed – Nodular
- 25.
- 26. Classification • Non–muscle-invasive bladdercancer • Muscle-invasive bladder cancer • The current WHO/International Society of Urological Pathology (ISUP) system classifies bladder cancers as low grade or high grade.
- 27.
- 28.
- 29. TNM Classification • TX- • T0 - • Tis - • T1 - • T2 - • T3 - • T4 -
- 30. TNM Classification • CIS- Carcinoma in situ, high-grade dysplasia, confined to the epithelium • Ta - Papillary tumor confined to the epithelium • T1 - Tumor invasion into the lamina propria • T2 - Tumor invasion into the muscularis propria: T2a, superficial muscularis propria; T2b, deep muscularis propria • T3 - Tumor involvement of the perivesical fat: T3a, microscopic invasion; T3b, macroscopic invasion • T4 - Tumor involvement of adjacent organs: T4a, invasion of prostatic stroma, seminal vesicles, uterus, or vagina; T4b, invasion of pelvic or abdominal wall
- 31. TNM Classification • N-Regional lymph nodes
- 32. TNM Classification N- Regionallymph nodes • NX - • N0 - • N1 - • N2 • N3
- 33. TNM Classification N- Regionallymph nodes • N0: No regional lymph node metastasis • N1: Metastasis in a single lymph node in true pelvis • N2: Metastasis in multiple regional lymph nodes in true pelvis • N3: Metastasis in common iliac lymph node(s).
- 34. TNM Classification M- Metastasis- •MX - • M0 - • M1 -
- 35. TNM Classification M- Metastasis- •M0: No distant metastsis • M1a: Non regional lymph nodes • M1b: Other distant metastasis.
- 36.
- 37. Clinical Features • Demography •Symptoms • Signs • Prognosis • Complications
- 38.
- 39. Demography • Incidence &Prevalence • Geographical distribution. • Race • Age • Sex • Socioeconomic status • Temporal behaviour
- 40. Demography • Incidence &Prevalence-
- 41. • Incidence &Prevalence- – Bladder cancer is the fourth most common cancer in men in the United States Demogrphy
- 42.
- 43. Demography • Geographical distribution. –In industrialized countries, 90% of bladder cancers are TCC. – In developing countries—particularly in the Middle East and Africa—the majority of bladder cancers are SCCs, and most of these cancers are secondary to Schistosoma haematobium infection.
- 44.
- 45. Demography Race. • The incidenceof bladder cancer is twice as high in white men as in black men in the United States.
- 46.
- 47. Demography • Age – Theincidence of bladder cancer increases with age, with the median age at diagnosis being 73 years; bladder cancer is rarely diagnosed before age 40 years.
- 48.
- 49. Demography • Sex – 3times more common in men than in women.
- 50.
- 51. Symptoms 7 warning signalsof cancer 1. Change in bowel or bladder habits. 2. A sore that does not heal. 3. Unusual bleeding or discharge. 4. Thickening or lump in the breast or elsewhere. 5. Indigestion or difficulty in swallowing. 6. Obvious change in a wart or mole. 7. Nagging cough or hoarseness.
- 52. Symptoms 7 warning signalsof cancer 1. Change in bowel or bladder habits. 2. A sore that does not heal. 3. Unusual bleeding or discharge. 4. Thickening or lump in the breast or elsewhere. 5. Indigestion or difficulty in swallowing. 6. Obvious change in a wart or mole. 7. Nagging cough or hoarseness.
- 53. Symptoms • Painless grosshematuria bladder cancer unless prooved otherwise. • Irritative bladder symptoms (eg, dysuria, urgency, frequency of urination) • Pelvic or bony pain, lower-extremity edema, or flank pain - In patients with advanced disease • Palpable mass on physical examination - Rare in superficial bladder cancer
- 54.
- 55. Signs • General Examination •Systemic Examination • Local Examination
- 56.
- 57. Signs • Local Examination- –Non ̶ muscle-invasive bladder cancer is typically not found during a physical examination. – In rare cases, a mass is palpable during abdominal, pelvic, rectal, or bimanual examination. – Attention to the anterior vaginal wall in women and the prostate in men may reveal findings that suggest local extension of bladder cancer.
- 58.
- 59. Prognosis • Morbidity • Mortalityrate • 5 year survival in Malignancy
- 60. Prognosis • The recurrencerate for superficial TCC of the bladder is high. • Non–muscle-invasive bladder cancer has a good prognosis, with 5-year survival rates of 82-100%. • Prognosis for patients with metastatic urothelial cancer is poor,
- 61.
- 62. Investigations • Laboratory Studies –Routine – Special • Imaging Studies • Tissue diagnosis – Cytology • FNAC – Histology – Germ line Testing and Molecular Analysis • Diagnostic Laparotomy.
- 63.
- 64. Investigations in Malignancy •For diagnosis • For staging • For Screening • For Monitoring
- 65.
- 66. Diagnostic Studies Laboratory Studies •Urinalysis with microscopy • Urine culture to rule out infection, if suspected • Voided urinary cytology with Fluorescence in situ hybridization (FISH). • Bladder washings can be obtained by placing a catheter into the bladder and vigorously irrigating with saline (ie, barbotage). • Urinary tumor marker testing
- 67. Diagnostic Studies Urinary tumormarker testing • Over 30 urinary biomarkers have been reported for use in bladder cancer diagnosis, but only a few are commercially available. • None have been accepted for diagnosis or follow-up in routine urologic practice or in guidelines.
- 68. Diagnostic Studies Cystoscopy • Theprimary modality for the diagnosis of bladder carcinoma • Permits biopsy and resection of papillary tumors
- 69. Diagnostic Studies Imaging Studies •X-Ray • USG • CT • Angiography • MRI • Endoscopy • Nuclear scan
- 70. Diagnostic Studies Imaging Studies •X-Ray • USG • CT – CECT abdomen, CT urography • Angiography • MRI • Endoscopy- Cystoscopy • Nuclear scan
- 71.
- 72. Differential Diagnosis • UrinaryTract Infection (UTI) and Cystitis • Hemorrhagic Cystitis: Noninfectious • Nephrolithiasis • Renal Cell Carcinoma • Renal Transitional Cell Carcinoma • Ureteral Trauma
- 73.
- 74. Management • Non–muscle-invasive bladdercancer carcinoma in situ [CIS] – -transurethral resection of bladder tumor (TURBT) with postoperative dose of intravesical chemotherapy and periodic cystoscopy. • Muscle-invasive - – Radical cystoprostatectomy in men – Radical cystectomy with anterior pelvic exenteration in women • Bilateral pelvic lymphadenectomy (PLND), standard or extended
- 75. Management • Creation ofa urinary diversion (eg, ileal conduit, Indiana pouch, orthotopic bladder substitution). • Neoadjuvant chemotherapy - May improve cancer-specific survival • Trimodality therapy- 1. TURBT 2. followed by concurrent radiation therapy 3. systemic chemotherapy.
- 76.
- 77. Chemotherapeutic regimens • Methotrexate,vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) • Gemcitabine and cisplatin (GC)
- 78. Targeted Therapy • Atezolizumab •Nivolumab • Avelumab • Pembrolizumab • Erdafitinib,
- 79.
- 80. Prevention • Screening • RiskReduction – Cigarette smoking – occupational exposure to carcinogens, with a recommendation that workers be informed of the risk and protective measures taken. • Aromatic hydrocarbons - common in metal processing • Aromatic amines - used in dyes • N-nitrosamines - found in rubber and tobacco • Formaldehyde
- 81. Guidelines • American UrologicalAssociation/Society of Urological Oncology (AUA/SUO) • European Association of Urology (EAU) • European Society for Medical Oncology (ESMO) • National Comprehensive Cancer Network (NCCN)
- 82. Get this pptin mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
- 84. Get my pptcollection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage
Editor's Notes
- #2 [email protected] 7697305442
- #84 https://emedicine.medscape.com/article/438262 [email protected] 7697305442