Ca bladder

Ca bladder

Ca bladder

Aetiology

@  occupation : anniline dye workers leather industry worker, paint industry n rubber industry workers
@ bilharziasis or schistosomiasis - squamous cell ca
@ chronic irritation by stones catheter : 95% of tumors originate in mucus membrane
@ chronic smoking
@ cyclophosphamide

# Pathology

1 Malignant villous tumors
@ they r transitional cell type
- villi r stunted swollen n resemble cauliflower
- can b sessile - high grade
- bladder wall more vascular
2 solid tumors are always malignant
3 carcinomatous ulcer arises in leukoplakia

# Histological types

@ transitional - 90%
@ squamous cell
@ adenocarcinoma arises 4m urachal remnants n urethral  glands
@ mixed variety
@ undifferentiated

C/F

1 painless intermittent haematuria
2 severe cystitis like symp occur in carcinomatous ulcer
3 later painful micturition
4 strangury painful micturition with bleeding n incomplete emptying of bladder
5 loin pain due 2 ureteric obstruction with hydronephrosis
6 surpapubic pain n groin pain n perineal pain due 2 nerve infiltration

Investigations

1 urine: cytology  of 3hour specimen

2 IVP: filling defect in bladder dilataton of ureter

3 USG : can detect blades ca n liver metastasis

4 CT : investigation of choice to know spread of disease - to know infiltration of muscle, perivesical tissue, n prostate n pelvic wall

5 cystoscopy : indications
haematuria with normal IVP and howes urinary tract symptom and malignant cells in urine cytology

6 Bimanual palpation rectoabdominally  in males n vaginoabdominally in females under GA

Staging

TNM
 Tis tumor insitu
 Ta - involving mucosa without invading lamina propria
 T1 - involving mucosa lamina propria n sub mucosa
 T2 - muscle layer
 T3a - muscle layer total thickness
 T3b - extendin 2 perivesical eat / peritoneum n adjacent organs
 T4 - rectum n prostate inv
 N0 - no lymph nodes
 N1 - nodal metastasis
 M0 - no distant metastasis
 M1 - distant met

Jewett Strong n Marshall staging

1 superficial/ non invasive
2 infiltrating / invasive
3 ca in situ

Rx

1 Tis Ta T1
a) transurethral resection of tumor
b) post operative intra vesical chemotherapy with thiotepa adriamycin n mitomycin retained inside bladder 4 1hour such 6 to 8 courses at weekly
c) BCG / interferon immunotherapy intravesically

2) T2 to T4
 Radical cystectomy : [removal of bladder with pericystic eat n prostate n seminal vesicles in both plus
 urethra in men n cervix uterus n ant vaginal vault n ovaries in women]
 followed by systemic chemotherapy
MVAC - Mtx, vinblastin, adriamycin, cisplatin

3] any T N1 M0 / any T N0 M1
systemic chemotherapy MVAC

4] small lesion involving muscle in vault of bladder partial cystectomy with growth margin 2 to 3 cm  followed  by intra vesical chemoth

5] radiotherapy
@ local
if lesion not anaplastic is 4cm / less after open diathermy excision  radio therapy given
@ deep x ray therapy
in un differentiated ca by using cobalt 60 / linear accelarator

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