12.9: Lower Urinary Tract Carcinoma

Question 1

What, technically, is included in the lower urinary tract?

Answer 1

• Renal pelvis
• Ureter
• Bladder
• Urethra

Question 2

What is the most common type of lower urinary tract cancer?

Answer 2

Urothelial carcinoma

Question 3

What, generally, is urothelial carcinoma? Where, anatomically, is this most often found?

Answer 3

• Malignant tumor arising from the urothelial lining of the lower urinary tract
• Bladder

Question 4

What is the main risk factor for urothelial carcinoma? (3)

Answer 4

• Polycyclic aromatic hydrocarbons in cigarette smoke
• Naphthylamine dyes
• Azo dyes

Question 5

What are the two drugs that prediposed to urothelial carcinoma?

Answer 5

Long term cyclophosphamide or phenacetin

Question 6

What is the classic symptoms of urothelial carcinoma?

Answer 6

Painless hematuria

Question 7

What are the two distinct pathways in the pathogenesis of urothelial carcinoma?

Answer 7

• Flat

- Papillary

Question 8

What is the papillary pathway of urothelial carcinoma? What is the progression here?

Answer 8

• Papillary growth with a fibrovascular core and a blood vessel running through it, and upon which epithelium is placed
• Low grade to high grade to invasion

Question 9

What is the flat pathway of urothelial carcinoma? What is the progression here?

Answer 9

Flat build up of high grade epithelial carcinoma, then invades

Question 10

Why does the flat pathway of urothelial carcinoma development start with high grade malignant cell proliferation?

Answer 10

-p53 mutations early

Question 11

What is the “field defect” associated with urothelial carcinoma?

Answer 11

The entire urothelial lining has been chronically insulted by carcinogens, meaning that all of it will eventually form tumors

Question 12

What does squamous cell carcinoma usually arise from within the lower urinary tract? Where (anatomically)?

Answer 12

Metaplastic squamous cell proliferation in the bladder

Question 13

What are the three risk factors for the development of squamous cell carcinoma of the lower urinary tract (infx agent, chronic diseases x2)

Answer 13

• Schistosoma haematobium
• Chronic cystitis
• Chronic nephrolithiasis

Question 14

What is Schistosoma haematobium? In whom is this commonly seen, and how?

Answer 14

Parasite found in middle eastern males transmitted by water, and leads to squamous cell carcinoma of the bladder.

Question 15

Where does Schistosoma haematobium reside in the human body? How does it evade immune detection? Where does it go to lay eggs?

Answer 15

• Liver
• coat with host antigen
• Goes to bladder to lay eggs, which are passed via micturition

Question 16

Where does adenocarcinoma of the lower urinary tract usually arise from? Why?

Answer 16

• Bladder

- arises from failure of involution of the urachal remnant, which is glandular

Question 17

What is the urachus?

Answer 17

Duct that connects the fetal yolk sac with the bladder to allow the bladder to drain waste into the yolk sac

Question 18

If adenocarcinoma is caused by failure of the urachal remnant to involunt, where in the bladder will it be seen?

Answer 18

The dome of the bladder

Question 19

What are the three major causes of adenocarcinoma of the bladder?

Answer 19

• Urachal remnant
• Cystitis glandularis
• Bladder Exstrophy

Question 20

What is cystitis glandularis?

Answer 20

Chronic inflammation of the bladder leads to dysplasia of the bladder epithelium to columnar epithelium

Question 21

What is Bladder Exstrophy?

Answer 21

Congenital failure to form the inferior portion of the bladder and abdominal walls, exposing the surface of the bladder to the outside world