Lower Urinary Tract Carcinoma Flashcards
What is a Urothelial Carcinoma also known as?
Transitional Cell Carcinoma
What is a Urothelial (Transitional Cell) Carcinoma?
Malignant tumor arising from the urothelial lining of the renal pelvis, ureter, bladder or urethra
What is the most common type of lower urinary tract cancer?
Urothelial (Transitional Cell) Carcinoma
Where does Urothelial Carcinoma usually arise?
In the bladder!
What is the major risk factor for Urothelial Carcinoma?
Cigarette Smoke (esp. polycyclic aromatic hydrocarbons)
What are three additional risk factors for Urothelial Carcinoma?
- Naphthylamine
- Azo dyes
- Long-term cyclophosphamide or phenacetin use
What is a particularly high yield risk factor of urothelial carcinoma?
Long-term cyclophosphamide or phenacetin use
What does Urothelial Carcinoma classically present with?
Painless Hematuria
What population is Urothelial Carcinoma usually seen in?
Older adults
What are the two distinct pathways Urothelial Carcinoma arises?
- Flat
2. Papillary
How does a Flat Urothelial Carcinoma develop?
Starts as high grade urothelilal carcinoma.
Develops as high-grade flat tumor and then invades.
What is a Flat Urothelial Carcinoma associated with?
Early p53 mutations!!
How does a Papillary Urothelial Carcinoma develop?
Tumor develops as a low-grade papillary tumor that progresses to a high-grade papillary tumor and then invades
What is a Papillary Urothelial Carcinoma made of?
It’s a fibrovascular pore with a blood vessel running through the middle.
What is Papillary Urothelial Carcinoma NOT associated with?
Early p53 mutation
What are two common traits of Urothelial Carcinoma?
- Often Multifocal
2. Often recur
Why is Urothelial Carcinoma often multifocal and recurrent?
Due to a “field defect”
What is a “field defect”?
The entire urothelium has been hit with carcinogens over time so the entire surface is mutated.
What is a Squamous Cell Carcinoma?
Malignant proliferation of squamous cells.
What does a Squamous Cell Carcinoma often involve?
Bladder!
What does squamous cell carcinoma arise in a background of?
Squamous metaplasia
Why is it interesting that sqamous cell carcinoma arises in squamous metaplasia?
Because the normal bladder surface is not lined by squamous epithelium.
What are three risk factors for Squamous Cell Carcinoma?
- Chronic cystitis (older women)
- Schistosoma haematobium (young, middle eastern men)
- Long-standing nephrolithiasis
What is the general idea behind all Squamous Cell Carcinoma risk factors?
They all cause chronic inflammation/irritation.
How does chronic cystitis lead to Squamous Cell Carcinoma?
Chronic inflammation –> Squamous metaplasia –> Squamous dysplasia –> Squamous cell carcinoma
What is an Adenocarcinoma?
Malignant proliferation of glands
What does an Adenocarcinoma usually involve?
Bladder!
What three things can cause Adenocarcinoma?
- Urachal Remnant
- Cystitis Glandularis
- Exstrophy
Where do urachal remnant Adenocarcinoma’s usually occur?
The tumor usually develops at the dome of the bladder.
How does cystitis glandularis lead to adenocarcinoma?
Cystitis –> patient has chronic bladder inflammation –> get columnar metaplasia —> adenocarcinoma
What is Exstrophy?
Congenital failure to form the caudal portion of the anterior abdominal and bladder walls (bladder exists outside body)
