B5.081 - Renal and Urinary Tumors Part 2

Question 1

Answer 1

normal bladder

Question 2

Answer 2

normal urothelium

Question 3

types of bladder cancer

Answer 3

mostly epithelial (90%)

can also have squamous or adeno

Question 4

risk fx for bladder cancer

Answer 4

smoking

schistosoma

aryl amines

analgesics

cycophosphamide

almost all sporadic

Question 5

urothelial carcinoma location

Answer 5

can occur anywhere lined by urothelial cells

Question 6

precursor lesions for urothelial carcinoma

Answer 6

non invasive papillary - arise from papillary hyperplasia, can be low or high grade

non invasive flat - aka carcinoma in situ, non BM invasion, always high grade

Question 7

UCC clinical presentation

Answer 7

paimless hematuris

50% have bladder muscle invasion, no precursor seen

Question 8

prognosis of UCC

Answer 8

depends on invasiveness

Question 9

Answer 9

radical cystectomy d/t UCC

Question 10

Answer 10

papillary non invasive low grade UCC

note - no breach of BM, papillary pattern

Question 11

Answer 11

papillary non in vaseive lowgrade UCC

Question 12

Answer 12

non invasive low grade papillary UCC

Question 13

low grade papillary UCC histo

Answer 13

orderly architecture, cytology

evenly spaced, maintain polarity

cohesive

minimal nuclear atypia

papillary architecture

Question 14

Answer 14

high grade papillary UCC

Question 15

Answer 15

high grade papillary UCC

Question 16

histo features of high grade UCC

Answer 16

dyscohesive

large, hyperchromatic nuclei, pleomorphism and atypia

frequent mitoses

disordered architecture, loss of polarity, higher risk for invasion and progression

Question 17

Answer 17

UCC in situ (flat)

Question 18

features of carcinoma in situ

Answer 18

flat lesion

dyscohesive

hyperchromatic enlarged cells

little cytoplasm

cytoscopy - no mass just erythema

mutifocality common

can spread to ureters and urethra

ONLY HIGH GRADE

Question 19

invasion and prognosis of UCC

Answer 19

80% high grade are invasive

advanced tumors can invade thru bladder into prostate, ureters, retroperitoneum

Question 20

genetic abnormalities for UCC

Answer 20

most random

chormosome 9 sometimes - 9p21 tumor suppression p16

loss of chromosome 9

Question 21

2 pathways of bladder cancer

Answer 21

low grade to invasion

high grade to invasion

Question 22

low grade to invasion pathway UCC

Answer 22

deletion of tumor suppressor genes on 9p and 9q

leads to superficial low grade papillary tumors

acquire p53 mutations

invade

Question 23

pathogenesis of high grade to invasion pathway in UCC

Answer 23

initial p53 mutation CIS/high grade tumors

loss of chromosome 9

invasion

Question 24

what upstages a tumor to T2

Answer 24

invasion of muscularis propria

Question 25

Answer 25

schostosoma hematobium in bladder

Question 26

Answer 26

schistosoma hematobium

Question 27

Answer 27

squamous cell carcinoma

Question 28

UCC diagnostic testing

Answer 28

cytoscopy with biopsy

urine cytology (cant recognize low grade)

FISH

Question 29

urine cytology indications

Answer 29

hematuria, follow pts with UCC, pts with high risk factors

NOT for asymptomatic screening

low sensitivity, depends on grade too (better for high)

super specific, false pos is rare

Question 30

treatment for UCC small localized low grade papillary

Answer 30

small localized low grade - transurethral resection/biopys and follow up cytology forever

Question 31

treatment for CIS/high grade papillary/multifocal/lamina propria invasion

Answer 31

CIS/high grade/multiple - topical immunotherapy

* given BCG eliciting inflammatory response destroying tumor

Question 32

treatment for invasive bladder cancer/refractory/met

Answer 32

radical cystectomy

chemo for mets