12.9 Lower Urinary Tract Carcinoma

Question 1

most common type of lower urinary tract cancer

-where usu arises?

Answer 1

Urothelial (transitional cell) carcinoma

-usu bladder

Question 2

Urothelial carcinoma

• main risk factor
• other risk factors (2)

Answer 2

1. main: cigarette smoke (polycyclic aromatic hydrocarbons)
2. napththylamine–found in azo dyes (certain hair dyes)
3. long term cyclophosphamid or phenacetin use

Question 3

squamous cell carcinoma of bladder

• mech
• risk factors (3)

Answer 3

• requires metaplasia of transitional to squamous epithelium. metaplasia is caused by a chronic inflammation
  1. chronic cystitis (usu older woman)
  2. Schistosoma hematobium (egyptian male)
  3. long standing nephrolithiasis

Question 4

adenocarcinoma of bladder

• mech
• causes (3)

Answer 4

• metaplasia of transitional epithelium.
  1. urachal remnant–urachus (duct that connects fetal bladder with yold sac remains.)
  2. cystitis glandularis–metaplasia to columnar epithelium
  3. exstrophy (congenital failure to form caudal portion of the anterior abdominal and bladder walls)

Question 5

Urothelial carcinoma

-classic symptoms, population

Answer 5

• painless hematuria
• older adults

Question 6

Lower urinary tract carcinoma:

list types

Answer 6

1. urothelial (transitional cell) carcinoma

requires metaplasia:

2. squamous cell carcinoma
3. adenocarcinoma

Question 6

Middle eastern male with bladder problems–think what

Answer 6

• squamous cell carcinoma of bladder, from schistosoma hematobium
• common in egyptian males

Question 7

what type of Urothelial carcinoma is assoc with early p53 mutations?

Answer 7

Flat carcinomas, but not papillary

Question 7

what is a urachal remnant?

what can it cause?

Answer 7

When the urachus does not disappear during development.

The urachus is a duct that connects the fetal bladder with the yolk sac (from dome of bladder to umbilical cord) so waste can be drained. If remnant, can cause adenocarcinoma of dome of bladder.

Question 9

would you see one or many Urothelial carcinomas in one pt?

Answer 9

Often can see many because of ‘field defect’–all kidney cells have been bombarded by carcinogens. only a matter of time before multiple tumors appear

Question 10

older adult with painless hematuria, suspect what?

Answer 10

urothelial carcinoma

Question 12

Urothelial carcinoma

• what pathways can it arise?
• describe them
• each assoc with what pathogenesis?

Answer 12

1. flat
   - begins as high-grade, then invades.
   - assoc with early p53 mutations
2. papillary
   - low grade, then high, then invade
   - forms on finger like projections with blood vessels inside
   - not assoc with early p53 mutations

Question 13

older woman with chronic cystitis:

what to worry about

Answer 13

-can lead to squamous cell carcinoma of bladder