L6 - Bladder and Kidney cancer Flashcards
1. Describe incidence, age, sex, geographical areas, predisposing factors, macroscopic and microscopic appearance of the common types of bladder and kidney cancers. 2. Briefly be bale to outline the investigation of patients in haematuria clinic.
Describe the epidemiology of bladder cancer?
- 10th most common in UK
Men: 8th
Women: 16th
50% survival for >10 years
49% preventable cases
What are risk factors for bladder cancer?
- Smoking (increases 4 fold)
- Exposure to arylamines in rubber or plastics manufacture
- Parasitic infection (schistoma)
- Pelvis radiotherapy
- chronic cystitis
- long term indwelling catheter
- chemotherapy with cyclophosphamide
On a molecular basis describe risk factors for bladder cancer?
- Oncogenes: P21 RAS oncogene (high grade)
- Tumour suppressor gene: TP53, 9q loss (low grade)
- Amplification & overexpression: over expression of epidermal growth factor (EGF)
Describe some clinical manifestations of bladder cancer?
- Painless gross haematuria.
- Irritative bladder symptoms
- Pelvic or bony pain, lower extremity oedema or flank pain.
- Palpable mass on physical examination (rare in superficial bladder cancer)
Examples of irritative bladder cancer?
Dyuria
Urgency
Frequency of urination
State the different types of bladder cancer?
Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
Sarcoma
Small cell cancer
Describe transitional cell carcinoma?
Most common.
Can arise anywhere in urinary tract e.g. renal pelvis, ureter, bladder and urethra.
Describe squamous cell carcinoma?
Associated with persistent inflammation from long-term indwelling catheters and bladder stones.
Describe adenocarcinoma?
Primary adenocarcinoma: derived from urothelium of bladder but exhibits pure glandular phenotype.
- haematuria common.
Describe non-muscle invasive bladder cancer?
Stage T1 cancer invades lamina propria but not the muscle of the bladder.
Where do transitional cell carcinoma’s arise from?
Stem cells that are adjacent to basement membrane of the epithelial surface.
Where do squamous cell carcinoma’s arise from?
Derived from bladder urothelium.
Has pure squamous phenotype.
What are carcinosarcomas?
Highly malignant tumours that contain a combination of mesenchymal and epithelial elements.
Describe small cell carcinosarcoma?
Highly malignant tumors that contain a combination of mesenchymal and epithelial elements.
Where do primary bladder lymphomas arise from?
Submucosa of bladder.
What are common bladder cancer presenting features?
Blood in urine - non visible haematuria - visible haematuria Weight loss, tiredness Loss of appetite General feeling of poor health
Bladder cancer stage Ta
Non-invasive papillary carcinoma
TX
Primary tumor cannot be assessed