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Cancer of the Bladder and Kidney

Cancer of the Bladder and Kidney

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Published by: james garcia on Sep 28, 2009
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12/24/2012

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Cancer of the bladder 
Cancer of the urinary bladder is seen more frequently in people aged 50-70 years and affects men more often that women.
Tumors usually arise at the base of the bladder neck and involve theureteral orifices, and bladder neck.
More common in whites than Asians or African Americans
Types
1.Transitional cell carcinoma2.adenocarcinoma3.Small cell Carcinoma4.Squamous cell carcinoma5.Rhabdomyosarcoma- occur in Children
There are two forms of bladder cancer:
1.superficial – which tends to recur 2.Invasive
Cause
1.Cigarette smoking.
Risk factor 
1.Smoking2.Chronic schistosomiasis (parasitic infection that irritates the bladder)3.Occupational Carcinogens in rubber, paint, plastics, metal, andautoimmotive exhaust4.history of pelvic irradiation5.Cyclophosphamide exposure
6.
High fat diet7.Chronic low fluid intake8.Slight increase risk with prostate CA.
Staging
The following stages are used to classify the location, size, and spread of the cancer,according to the TNM (tumor, lymph node, and metastasis) staging system:
 
Stage 0
: Cancer cells are found only on the inner lining of the bladder.
Stage I
: Cancer cells have proliferated to the layer beyond the inner lining of theurinary bladder but not to the muscles of the urinary bladder.
Stage II
: Cancer cells have proliferated to the muscles in the bladder wall but notto the fatty tissue that surrounds the urinary bladder.
Stage III
: Cancer cells have proliferated to the fatty tissue surrounding theurinary bladder and to the prostate gland, vagina, or uterus, but not to the lymphnodes or other organs.
Stage IV
: Cancer cells have proliferated to the lymph nodes, pelvic or abdominalwall, and/or other organs.
Recurrent
: Cancer has recurred in the urinary bladder or in another nearbyorgan after having been treated
Pathophysiology
70-80% is superficial (in lamina propria or mucosa)Usually highly differenciated with long survival
Initial event seems to be activation on oncogene on chromosome 9
20% of tumors are invasive (deeper than lamina propia) at presentation:Tend to be high grade with worse prognosis.
Clinical Manifectation
1.
Hematuria-gross or microscopic, usually painless
2.
Urinary symptom- frequency, urgency and dysuria3.Any alteration of voiding or change in the urine is indicative
4.
Pelvic or back pain may occur with metastasis
Assessment and Diagnostic Methods
Biopsies of tumor and adjacent mucosa are definitive, but the followingprocedures are also used:1.Cystoscopy, biopsy of tumor and adjacent mucosa2.Excretory urography3.Computed Tomography (CT) scan
 
4.Ultrasonography5.Bimanual examination under anesthesia6.Cytologic examination of fresh urine and saline bladder washings
7.
Molecular assays, bladder tumor antigens, adhesions molecules andothers are being studied
Medical MangementSurgical Management
1.
Transurethral resection (TUR) or fulguration for simple papillomas withintravesical bacilli Calmette-Guerin (BCG) is the treatment of choice
2.
Monitoring of benign papillomas with cytology and cystoscopy periodicallyfor the rest of patient’s life3.Simple cystectomy or radicak cystectomy for invasive or multifocalbladder cancer 
Pharmacology Therapy
1.
Chemotherapy with a combination of Methotrexate, 5-fluoroucil (5-FU),vinblastine, doxotubucin (Adriamycin) and cisplatin ( (M-VAC) and newagents gemitabine and taxanes, possibly by topical chemotherapy applieddirectly to the bladder wall.2.Intraversal BCG (effective with superficial transpositional cell carcinoma)3.Cytotoxic agent infusions through the arterial supply of the involvedorgan4.4. Formalin, phenol, or silver nitrate instillations to achieve relief of hematuria and strangury (slow and painful discharge of urine) in somepatients.
Radiation Therapy
1.Radiation of tumor preoperatively to reduce micro extension and viability2.Radiation therapy in combination with surgery to control inoperabletumors3.Hydrostatic therapy: for advanced bladder cancer or patients withintractable hematuria (after radiation therapy)
4.
Hematuria Therapy: for advanced bladder cancer or patients withintractable hematuria (after radiation therapy)

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