40. Urothelial carcinoma: Cancers of the bladder, ureter, renal pelvis

Question 1

What is 40. Urothelial carcinoma

Answer 1

Transitional Cell Carcinoma of the

Renal pelvis/calyce, Bladder, Ureter,

Question 2

What is the grading for urothelial carcinoma

which are low and high grade

Answer 2

G1 = well differentiated urothelial tumour-> low grade

G2 = moderately differentiated urothelial tumour -> low grade

G3 = poorly differentiated urothelial tumour-> high grade

G4 = undiffrentiated differentiated urothelial tumour> high grade

Question 3

presentation of urothelial carcinoma

main sx?

sx d/2 imcomplete obstruction of the ureter

effect of enlarged organ

Answer 3

• Most common symptomvis be hematuria •

Other possible symptoms:

hydronephrosis in case of incomplete obstruction e.g. caused by tumour for example at the ureter

blunt pain d/2 Enlargement of the organ causes

Question 4

how is urothelial carcinoma of renal calyx, blader and urethrea Diagnosed

• how is urine collected for cytology
• which tumors can’t be detected by US
• which 3 imaging modalities detect filling defects
  
  • which ones need contrast
    
    • how is contrast delivered in one of these modalities
• dx betw. mg tumour and stones

Answer 4

• Urine cytology
• cystoscopy and catheterisation of urethra

Imaging

• US not sensitive to detect tumours of the urethra and renal pelvis
  
  • Which methods detect cardinal x ray sx’s of mg tumors

1. IntraVenous Urography with contrast material/CT w/ contrast
2. Retrograde Ureteropylography

• Cardinal x ray symptoms = irregular filling defect connected to uteric wall

Question 5

how to dx bet/w mg urothelial tumour and stones on imaging

Answer 5

• irregular filling defect connected with ureteric wall means malignant tumour
• regular filling defect not connected with ureteric wall — stones — radioluscent/radionegative stones

Question 6

Treatment if urothelilal carncinoma’s

what is the ideal treatment

which parts of the bladder are excised/ resected in addition

measures for follow up and the 3 indications

Answer 6

Best treatment for UUT = nephro-utetero-ectomy

• excision of bladder cuff ipsilaterally
• along with partial resection of urinary bladder at the site of issue
  
  • T0-T1 = treatment is TRANSURETHERA RESECTION
  • T2-T4 = rx is RADICAL CYSTECTOMY

Follow up menthod for urothelial carcinoma= cystoscopy

• indications are
  
  • 1)Hematuria 2) after surgery for UUT and 3)relapses

Question 7

what is concomicant bladder metastasis in urothelial carcinoma

what is the cause

Answer 7

Concomittant Bladder Metastasis is common in urothelial cancers as the urinary stream can cause cancers to develop in the bladder

clinically seen as simultaneous bladder tummor in urothelial cancers

Question 8

what does it mean if a tumor is found in the urinary bladder after follow up cystoscopy

Answer 8

Metastatic bladder tumor

Question 9

definite diagnosis of urrothelial cancers

Answer 9

Radiolucent calyces/?