Bladder Cancer

Definition
• Bladder cancer is an abnormal mass that can be found in the bladder.
• Bladder carcinoma is a superficial tumor.
• This tumor is old over time can hold infiltration into phopria, muscle
& fat lamina perivesika which then spread directly to the surrounding
network.
Epidemiology
• Urinary tract malignancies most often occur after prostate cancer.
• About 7% of new malignancy cases in men and 2% in women are
bladder cancer urinary tract.
• White people have a higher risk of suffering bladder cancer than black
people.
• Average age patient when diagnosed with bladder cancer is 65 years
old, with 75% are local malignancies and 25% have metastasized to
the gland regional lymph.
Etiology
Predisposing factors bladder cancer :
• Smoke
• Work
• Age
• Gender
• Chronic irritation and bladder infections
• History of ferocity
• Congenital bladder abnormalities
• Family history
• Chemotherapy and radiotherapy
Pathophysiology
Hydronephrosis and hiroureter -> presence of obstruction of urine flow (anatomic or
physiological) -> increased ureteric pressure -> decreased GFR because of resistance ->
impaired tubular function. if the flow is short -> reversible abnormalities. if chronic
blockage -> tubular atrophy and permanent nephron loss.

On the urogram
• Early hydronephrosis -> flattening.
• Advanced circumstances -> multiply in the form of a stick (clubbing).
• More severe conditions -> destruction of the parenchyma and enlargement of the
urinary tract, papilla compression, thinning of the parenchyma around kalises, and ->
progressive cortical atrophy -> hydronephotic sac formation (balloning).

On ultrasound
• Mild hydronephrosis -> hypoechoic appearance in the center of the kidney.
• Moderate hydronephrosis -> dilation of peilocalikises
• Severe hydronephrosis -> kalises (a lobulated economic free zone, renal parenchyma is
no longer clear)
Clinical Manifestations
• Intermittent blood urination
• Feeling hot when urinating
• Feel like urinating
• Frequent urination especially at night and in the later phases it is
difficult to urinate
• Constant suprapubic pain
• Body heat and feeling weak
• Low back pain due to nerve pressure
• Pain on one side due to hydronephrosis
Diagnosis
 Anamnesis

 Physical examination
 Thickening of the bladder wall and bump
 If the cancer has spread to other organs -> supraclavicular
lymphadenopathy & hepatomegaly
If it spreads to the bone -> pain or fracture
 Supporting investigation
• Laboratory :
Hb decreases
Lukositosis
Right Finger Tapping (RFT) normal
Lymphopenia (N = 1490-2930)

• Radiology :
Excretory urogram
Retrograde cystogram
Fractionated cystogram
Angiography

• Cystocopy and biopsy

• Cystology
Governance
Operation
1. Transurethral resection for single / multiple papillomas
2. Performed on stages 0, A, B1 and grade I-II-low grade
3. Total cystotomy with removal of kel. Prostate and urinary diversion
for:
- Transurethral cel tumors of grade 2 or more
- Aquamosa cal Ca on stage B-C
Radiotortion
- Given to radiosensitive tumors such as undifferentiated grade III-IV and stage B2-C.
- Radiation is given preoperatively for 3-4 weeks, dose 3000-
4000 Rads. Patients are evaluated for 2-4 weeks with
cystoscopy interval, chest radiograph and IVP, then 6 weeks
after radiation is planned surgery. Post additional radiation surgery
2000-3000 Rads for 2-3 weeks.

Chemotherapy
Anti-cancer drugs:
- Citral, 5 fluoro uracil
- Topical chemotherapy is Thic-TEPA, 5 - Fluorouracil (5-FU) and doxorubicin (adriamycin)
- Thiotepa
Complications
• Secondary infection when the tumor is ulcerated
• Urinary retention if the tumor invades
• Hydronephrosis bladder neck because the ureter has occlusion