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Bladder tumors > Malignant bladder tumors > Flashcards

Malignant bladder tumors Flashcards

1
Q

This is a premalignant bladder lesion (pre-squamous cell carcinoma), composed of keratinizing squamous metaplasia

A

Leukoplakia

*not to be confused with pseudomembranous trigonitis/squamous metaplasia, seen in young females (b/c estrogen)

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2
Q

This is a finding of severe dysplasia, occurring in 10% of all bladder cancer patients (associated with high-grade tumors with high risk of muscle invasion progression), and is commonly symptomatic with urgency, frequency, and dysuria.

A

Carcinoma in situ (CIS)

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3
Q

Treatment of CIS?

A

intravesical BCG

*Early cystectomy for BCG non-responders

Valrubicin (chemotherapy)

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4
Q

Most common type of bladder cancer in USA?

A

transitional cell carcinoma (TCC)

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5
Q

TCC stage if limited to the mucosa?

A

Ta

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6
Q

TCC stage if in the muscularis mucosa

A

T1

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7
Q

TCC stage if in the lamina propria

A

T1

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8
Q

TCC stage if in the perivesicle fat?

A

T3

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9
Q

TCC stage if in the muscularis propria?

A

T2

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10
Q

TCC stage if in the prostatic stroma?

A

T4

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11
Q

If primary urethral TCC is in the prostatic stroma, what is the stage?

A

T2

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12
Q

TCC stage if through the adventitia?

A

T4

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13
Q

Non muscle invasive bladder cancer includes which stages?

A

Ta, T1, CIS

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14
Q

Which variant of NMIBC gives an ominous prognosis and the treatment is immediate cystectomy, as it is highly resistant to intravesical BCG and neoadjuvant chemotherapy?

A

Micropapillary variant and also sarcomatoid variant

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15
Q

If a NMIBC is clinical stage T1 with lymphovascular invasion, what is the tx?

A

Early cystectomy +/- neoadjuvant chemotherapy

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16
Q

Altogether, which variants of NMIBC do you skip BCG and go straight to cystectomy and chemotherapy?

A
  1. T1 with lymphovascular invasion
  2. Micropapillary variant
  3. Sarcomatoid variant
  4. Nested variant (very rare, aggressive form)
17
Q

Causes of squamous cell carcinoma of bladder?

A
  1. Bilharzial SqCC (schistosoma haematobium)

2. Chronic irritation (chronic catheter, UTI, bladder calculi)

18
Q

SqCC of bladder, common mutations?

A

9p and 16p

19
Q

SqCC of bladder most common site of metastasis?

A

bone

20
Q

SqCC of bladder, this specific compound is found in urine

A

Psoriasin

21
Q

Is SqCC of bladder treated any differently than TCC?

A

No

22
Q

Types of adenocarcinoma of bladder?

A

Primary vesical

Urachal

23
Q

Pathogenesis of primary vesical adenocarcinoma?

A

usually at bladder dome, response to chronic inflammation. Mucin-producing and poorly differentiated. Signet ring adenocarcinomas may produce linitis plastica of the bladder.

most commonly associated with extrophy

24
Q

Pathogenesis of urachal adenocarcinoma

A

Located at bladder dome, due to a persistent/patent urachus

One of the few indications for a partial cystectomy

25
Q

What is the dissection template for a partial cystectomy of a persistent urachus? (Anterior, lateral, superior, and inferior)

A

Anterior: include posterior rectus sheath

Lateral: area between medial umbilical ligaments

Superior: include the umbilicus

Inferior: bladder cuff of benign urothelium surround urachal attachment

26
Q

Before treating adenocarcioma (just like TCC), what must you r/o?

A

Metastatic etiology, since adenocarcinoma is <2% of all bladder cancers

27
Q

This is a rare, poorly differentiated neuroendocrine bladder epithelial tumor that is very aggressive, with a five year survival rate of all stages near 20%

A

Small cell carcinoma

28
Q

What are some immunohistochemical stains for neuroendocrine small cell carcinoma of the bladder?

A 
neuron-specific Enolase
**Synaptophysin
Serotonin
**S-100
**Chromogranin
29
Q

Tx of small cell carcinoma of bladder?

A

**1st line is chemotherapy (VP-16 = cisplatin, etoposide), then radical cystectomy if responds

30
Q

What is the treatment for symptomatic bone metastasis?

A

Radiotherapy

Bladder tumors (7 decks)

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