Bladder cancer Flashcards

1
Q

Because invasion of the (1) layer of the bladder greatly affects the prognosis and survival rate of bladder cancer, it is not surprising that (2) lesions can have a worse prognosis than (3) lesions which are exophytic growths within the (4)

A
  1. muscle
  2. flat carcinoma-in-situ
  3. papillary
  4. bladder lumen
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2
Q

(1) is an important predictor of bladder cancer prognosis because only about 10% of low grade cancers (2) whereas nearly 80% of high grade ones (2)

A
  1. Nuclear grade

2. invade muscle

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3
Q

Invasive bladder cancers can invade local structures like (1) and tend to spread to (2) before metastasizing to (3)

A
  1. prostate, seminal vesicle and ureter
  2. regional lymph nodes
  3. liver, lungs or bone marrow
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4
Q

Flat transitional cell carcinomas often present as (1). They can be (2) and extensive.

A
  1. reddish areas of bladder wall thickening without a clear mass
  2. multifocal
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5
Q

The precursor for invasive flat transitional cell carcinomas are (1) which is usually high nuclear grade

A
  1. transitional cell carcinoma-in-situ (CIS)
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6
Q

Papillary transitional cell carcinomas of the bladder may develop from (1) and often become (2) lesions which can extend into the (3)

A
  1. papillary urothelial hyperplasia
  2. exophytic
  3. bladder lumen
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7
Q

Like at other sites, papillary carcinoma within the bladder consists of (1) cells which surround a central core which contains (2).

A
  1. atypical pleiomorphic

2. connective tissue and blood vessels

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8
Q

(1) can be extensive and give a cauliflower like appearance to the tumors grossly

A
  1. Papillary fronds of papillary transitional cell carcinomas of the bladder
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9
Q

Invasive bladder cancer is usually (1), although worldwide about 10% is (2), associated with (3) which causes a premalignant (4) metaplasia

A
  1. transitional epithelium
  2. squamous cell carcinoma
  3. schistosomiasis mansoni
  4. squamous
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10
Q

Unlike other sites in the body (except skin) where cancers are usually single, bladder cancer can occur at multiple sites at the same time, so it is (1) in nature

A
  1. multifocal
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11
Q

Classically, bladder cancers present with (1) which can either be visible to the patient or physician or only present by microscopic exam

A
  1. painless hematuria
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12
Q

If the cancer enlarges, it can lead to urethral obstruction which would present as (1) (inability to begin urine flow) or (2) (a sudden feeling that you need to urinate ) or (3) (painful urination).

A
  1. hesitancy
  2. urgency
  3. dysuria
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13
Q

(1) is an important risk factor for bladder cancer and some occupational or environmental exposures are associated with the development of bladder cancer including (2)

A
  1. Cigarette smoking

2. 2 napthylamine and pelvic irradiation

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14
Q

(1) can cause a hemorrhagic cystitis (inflammation of the bladder) which is associated with an increased risk of bladder cancer

A
  1. Cyclophosphamide
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15
Q

Mutations which are associated with bladder cancer include?

A

p16, p53 and a loss of chromosome 9

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16
Q

One approach to screening symptomatic patients for bladder cancer is (1) in which malignant cells are identified because of their nuclear changes and increased nuclear to cytoplasmic ratio

A
  1. urine cytology
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17
Q

If a patient has malignant cells identified by urine cytology, then (1) (transurethral endoscopy of the bladder) can be performed and (2) can be biopsied

A
  1. cystoscopy

2. areas of thickened mucosa or papillary lesions

18
Q

intermediate between nonkeratinizing squamous and pseudostratified columnar epithelium

A

Transitional eptihelium

19
Q

1) is single layer of umbrella cells, which are large and elliptical with abundant eosinophilic cytoplasm and often binucleation or prominent nucleoli

A

Superficial urothelium (umbrella cell layer)

20
Q

Muscularis layer very prominent in the 1) and very thin in the 2)

A

1) Bladder 2) ureter

21
Q

Relaxed umbrella cells:

  • AKA relaxed surface cells
  • They are ____ when the bladder is NOT constricted.
A

domed shape

22
Q

____ invasion of bladder–> 30% 5-year survival;

A

muscularis

23
Q

Grade is important:

(a) ___ papillary carcinomas: 80% will invade
(b) ____ papillary carcinoma: 10% will invade over time.

A

High grade; low grade

24
Q

When bladder cancer spreads, they can spread to surrounding structures: ___ and ____; they can spread upwards into the ureter or into the retroperitoneal space. They can also spread to regional lymph nodes first then to ____, _____ and even bone marrow

A

prostate, seminal vesicle;

liver, lung

25
Q

Flat non-invasive urothelial carcinoma develops as a ____

Papillary tumors develop as _____

A

HIGH grade and then invades;

LOW grade, then go to HIGH grade then invade

26
Q

flat non-invasive urothelial carcinoma–> precursor is ___.

Such lesions are considered to be _____

A

carcinoma in situ or CIS; high grade

27
Q

non-invasive papillary tumors originate from____ which is _____

A

papillary urothelial hyperplasia; low grade

28
Q

50% of bladder cancers have no _____

A

precursor

29
Q

Low grade papillary lesion: circumferential growth around _____

A

fibrovascular core

30
Q

Grossly: mucosal reddening, granularity, or thickening without mass.

A

Flat CIS

31
Q

Multifocal, may involve most of the bladder,extend to ____

If untreated, 50% to 75% of CIS cases progress to ____ (High)

A

ureters and urethra;

muscle-invasive cancer

32
Q

Papillary: fibrovascular core surrounded by

___ and ___

A

loops and fronds

33
Q

Invasive Bladder Cancer characterisitics

1, 2, 3

A
  1. Invasion
  2. Fungating
  3. Necrosis (yellow amorphous)
34
Q

this is unusual for cancer, since most cancers tend to be single, whereas bladder cancer are ___

A

multifocal

35
Q

Bladder cancers are staged using the TNM: tumor size, nodes, metastasis.
___invades into the muscularis propria, at which it becomes a lot more life-threatening.
____ means hasn’t invaded into the lamina propria yet.
___ through the wall into other tissues

A

T3;
TIS: T in situ
T4

36
Q

1) is a good screening tool to see if any changes present, and if they are can do 2) and biopsy

A

1) urine cytology

2) cystoscopy

37
Q

Urine cytology–> looks at 3 things

A

Pleiomorphism, Nuclear:cytoplasm ratio, nuclear changes (clearing and nucleoli)

38
Q
Schistosoma haematobium infections
(Egypt, Sudan) ova produce chronic
inflammatory response that induces
progressive 1)
which then develops into 2)
A

1) mucosal squamous metaplasia

2) squamous carcinoma

39
Q
  1. Bladder cancers frequently have chromosome___deletions where ___ was located; this gene encodes an inhibitor of a cyclin-dependent kinase or
    the related tumor suppressor gene p15
  2. Also p53 mutations (prevent apoptosis)
A
9; tumor suppressor
gene p16 (INK4a)
40
Q

tumor suppressor gene p16 (INK4a) encodes an____of a _____ or
the related tumor suppressor gene ____

A

inhibitor ; cyclin-dependent kinase; p15

41
Q
  1. higher in men 3:1
  2. developed nations
  3. urban dwellers.
  4. 80% age 50-80
A

Bladder cancer