Urothelial Tumors Flashcards
What is an upper urinary tract tumor
Neoplastic growth that affects lining of urinary tract from the calyx to the distal ureter
Which is more common, bladder urothelial cancer or upper urinary tract tumor
Bladder urothelial cancer
Main difference between bladder urothelial cancer and upper urinary tract tumors
Upper urinary tract tumors are less common and linked with familial syndromes
Centage of urothelial tumors involving the renal pelvis or ureter
5%
Which countries have the highest incidence in urothelial cancer representing 40% of all renal cancer there
Balkan countries
Who is more at risk of upper urinary tract tumors , men or women?
Men twice as likely
Who is more at risk of upper urinary tract tumors, whites or blacks?
Whites , twice as likely
Factors of upper urinary tract tumors
Dietary exposure to aristolochic acid
Smoking
Coffee consumption
AnalGesic abuse
Arsenic poisoning
Occupation in chemical , petroleum , plastic , coke, asphalt , tar
Aniline dye
Chronic inflammation , infection
Exposure to chemotherapeutic agents
Heredity ( lynch syndrome II)
Location of ureteral tumors
Lower part of ureter mostly 70%
Mid ureter 25%
Proximal ureter 5%
True Or false , patients with upper urinary tract tumors are at risk of development of bladder cancer
True
Centage of incidence of bladder cancer in people with upper urinary tract tumor
15 to 75% within five years
Prognosis . of upper tract urothelial cancer
Poor
Percentage of patient that presents with upper tract tomorrow already in metastatic disease
19%
Method of spread of upper tract tumor tumor
Epithelial
Lymphatic
hematogenous
Main form of upper tract tumors
Urothelial cancer’s
Main type of urothelial cancer
Transitional cell
Other types of urothelial cancer
squamous cell cancer
adenocarcinomas
most common symptom in upper tract urothelial tumors
hematuria gross or microscopic
Gun must come on symptom in urothelial tumors
Flank pain- dull
Percentage of asymptomatic patients diagnosed with incidental lesion found a radiologic evaluation
15
Presentation of patients when advanced dx
Flank or Abdominal mass
weight loss
anorexia
bone pain
Situation of upper tract lesion
Ct urography
IVU
Mri
Cytoscopy
Flexible and rigid ureteroscopy
Urine cytology
Findings on radiologic evaluation in upper tract lesions
Radiolucent filling defects
obstruction or incomplete filling of parts of upper tract
non-visualization of collecting system
Methods of investigation used to determine main contribution of diseased and presumed normal kidney to patient overall renal function
Split function renal scan
method of investigation used in staging of upper tact tumort
ct or MRI
What investigation do you used to always excludes coexistent bladder lesions in upper urinary tract tumor
Cystoscopy
Single most important determinant of outcome in upper urinary tract tumors
Tumor stage ( tnm staging )
Patient for surgery in upper urinary tract tumors
When nephron sparing for preservation of renal function required
Solitary kidney tumor
synchronous bilateral tumor
predisposition to multiple recurrences
Patient for open radical nephroureterectomy
Large high-grade invasive tumors of renal pelvis and proximal ureter
Indication for open segmental ureterectomy ureteroureterostomy
Noninvasive grade 1 and 2 tumors of proximal or midureter too large for complete endoscopic ablation
Grade 3/ invasive tumor with nephron sparing as goal
Indications for Distal ureterectomy, direct neocystostomy, ureteroneocystostomy with bladder psoas,muscle hitch or boari flap
Tumor in distal ureter that can’t be removed by endoscopy
Treatment of metastatic disease of urothelial tumors
Systemic chemotherapy used in TCC Of bladder
Most common benign tumors of the bladder
Epithelial metaplasia
Leukoplakia
inverted papilloma
nephrogenic adenoma
Leiomyoma
cystitis cystica
cystitis glandularis
Etiology of malignant tumors of the bladder
Aniline dyes
radiation
chemotherapy
artificial sweeteners
Vesicle schistosomiasis
vesicle calculi
Symptoms of bladder urothelial carcinoma
Gross painless hematuria
Investigation in bladder cancer
Cystoscopy, urine cytology for hematuria
Ct scan
PSA blood test
Main diagnostic test for bladder cancer
Cystoscopy
Biopsy
Urine markers of urothelial cancers
BTA stat
BTAtrak
NMP22
ImmunoCyt
Initial treatment for visible lesions of bladder treatment
Transurethral resection of bladder tumor - TURBT
Goal of TURBT
Remove all visible tumor
obtain specimen for pathologic examination for stage and grade determination
Main Chemotherapeutic agents used perioperatively To prevent tomorrow in plantation in bladder cancer
Mitomycin C
Adriamycin
Intravesical BCG
Indications for radical cystectomy and bilateral pelvic and iliac lymphadenectomy
Muscle invasive tumor
What are the indications for partial cystectomy
Visible Lesion
Location is suitable for bladder preservation mostly on dome and away from ureteral orifices
Management Metastatic bladder cancer
Systemic combination chemotherapy ( cisplatin based first Line)
