TCC of Urinary Epithelium

Question 1

PATHOLOGY: TCC

Answer 1

• Affects renal pelvis, ureter, bladder (rarely urethra)
• Spectrum disease: superficial papilliferousgrowth ==> invasive TCC
  
  • 70% superficial in nature
• Bladder TCC 5th common cancer death cause

Question 2

RISK FACTORS: TCC

Answer 2

• Smoking
• Aromatic amines (clothing dyes, printing)

Question 3

What are the causes of non-TCC bladder cancer?

Answer 3

Squamous Cell

• Chornic irritation, schistosomiasis infestation, indwelling catheter, repeated surgical interventions

Adenocarcinoma (rare)

• Presents middle age, associated w/ urachus

Question 4

CLINICAL FEATURES: TCC

Answer 4

• Painless Haematuria
• Dysuria
• Urinary retention
• Recurrent UTIs
• Renal colic (blood clot)

Question 5

INVESTIGATIONS: TCC

Answer 5

Endoscopy

• flexible cystoscopy (GOLD)
• Imaging*
• CT urography, USS, IVU = upper tract disease
• MRI/CT = extravesical spread
• Pathology*
• Urine cytology

Question 6

MANAGEMENT: TCC

Answer 6

1. Superficial

• Remove: endoscopic resection
  
  • Recurrence common = regular survelliance checks
• Intravesical chemotherapy

2. Invasive disease

• Radical cystectomy (50% 5 year survival) or radical radiotherapy (40% 5yr survival)
• Prognosis related to initial disease stage

Question 7

What is the overall prognosis for bladder cancer at all disease stages?

Answer 7

23% mortality