Bladder cancer Flashcards
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)
- muscle
- flat carcinoma-in-situ
- papillary
- bladder lumen
(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)
- Nuclear grade
2. invade muscle
Invasive bladder cancers can invade local structures like (1) and tend to spread to (2) before metastasizing to (3)
- prostate, seminal vesicle and ureter
- regional lymph nodes
- liver, lungs or bone marrow
Flat transitional cell carcinomas often present as (1). They can be (2) and extensive.
- reddish areas of bladder wall thickening without a clear mass
- multifocal
The precursor for invasive flat transitional cell carcinomas are (1) which is usually high nuclear grade
- transitional cell carcinoma-in-situ (CIS)
Papillary transitional cell carcinomas of the bladder may develop from (1) and often become (2) lesions which can extend into the (3)
- papillary urothelial hyperplasia
- exophytic
- bladder lumen
Like at other sites, papillary carcinoma within the bladder consists of (1) cells which surround a central core which contains (2).
- atypical pleiomorphic
2. connective tissue and blood vessels
(1) can be extensive and give a cauliflower like appearance to the tumors grossly
- Papillary fronds of papillary transitional cell carcinomas of the bladder
Invasive bladder cancer is usually (1), although worldwide about 10% is (2), associated with (3) which causes a premalignant (4) metaplasia
- transitional epithelium
- squamous cell carcinoma
- schistosomiasis mansoni
- squamous
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
- multifocal
Classically, bladder cancers present with (1) which can either be visible to the patient or physician or only present by microscopic exam
- painless hematuria
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).
- hesitancy
- urgency
- dysuria
(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)
- Cigarette smoking
2. 2 napthylamine and pelvic irradiation
(1) can cause a hemorrhagic cystitis (inflammation of the bladder) which is associated with an increased risk of bladder cancer
- Cyclophosphamide
Mutations which are associated with bladder cancer include?
p16, p53 and a loss of chromosome 9
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
- urine cytology
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
- cystoscopy
2. areas of thickened mucosa or papillary lesions
intermediate between nonkeratinizing squamous and pseudostratified columnar epithelium
Transitional eptihelium
1) is single layer of umbrella cells, which are large and elliptical with abundant eosinophilic cytoplasm and often binucleation or prominent nucleoli
Superficial urothelium (umbrella cell layer)
Muscularis layer very prominent in the 1) and very thin in the 2)
1) Bladder 2) ureter
Relaxed umbrella cells:
- AKA relaxed surface cells
- They are ____ when the bladder is NOT constricted.
domed shape
____ invasion of bladder–> 30% 5-year survival;
muscularis
Grade is important:
(a) ___ papillary carcinomas: 80% will invade
(b) ____ papillary carcinoma: 10% will invade over time.
High grade; low grade
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
prostate, seminal vesicle;
liver, lung
Flat non-invasive urothelial carcinoma develops as a ____
Papillary tumors develop as _____
HIGH grade and then invades;
LOW grade, then go to HIGH grade then invade
flat non-invasive urothelial carcinoma–> precursor is ___.
Such lesions are considered to be _____
carcinoma in situ or CIS; high grade
non-invasive papillary tumors originate from____ which is _____
papillary urothelial hyperplasia; low grade
50% of bladder cancers have no _____
precursor
Low grade papillary lesion: circumferential growth around _____
fibrovascular core
Grossly: mucosal reddening, granularity, or thickening without mass.
Flat CIS
Multifocal, may involve most of the bladder,extend to ____
If untreated, 50% to 75% of CIS cases progress to ____ (High)
ureters and urethra;
muscle-invasive cancer
Papillary: fibrovascular core surrounded by
___ and ___
loops and fronds
Invasive Bladder Cancer characterisitics
1, 2, 3
- Invasion
- Fungating
- Necrosis (yellow amorphous)
this is unusual for cancer, since most cancers tend to be single, whereas bladder cancer are ___
multifocal
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
T3;
TIS: T in situ
T4
1) is a good screening tool to see if any changes present, and if they are can do 2) and biopsy
1) urine cytology
2) cystoscopy
Urine cytology–> looks at 3 things
Pleiomorphism, Nuclear:cytoplasm ratio, nuclear changes (clearing and nucleoli)
Schistosoma haematobium infections (Egypt, Sudan) ova produce chronic inflammatory response that induces progressive 1) which then develops into 2)
1) mucosal squamous metaplasia
2) squamous carcinoma
- 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 - Also p53 mutations (prevent apoptosis)
9; tumor suppressor gene p16 (INK4a)
tumor suppressor gene p16 (INK4a) encodes an____of a _____ or
the related tumor suppressor gene ____
inhibitor ; cyclin-dependent kinase; p15
- higher in men 3:1
- developed nations
- urban dwellers.
- 80% age 50-80
Bladder cancer
