A 67-year-old chronic heavy smoker presents with 2 weeks history of frank hematuria. USG pelvis shows a filling defect. Most probable diagnosis:
Correct Answer: Transitional cell carcinoma of bladder
Description: Ans: (d) Transitional cell carcinoma of bladderRef: Bailey and Love's Short Practice of Surgery, 26th editionBladder CancerUrothelial/Transitional cell cancer - most common typeSquamous cell carcinoma (most prevalent form in Schistosomiasis endemic areas)Adenocarcinoma (usually arise in the fundus of the bladder at the site of urachal remnant)Risk FactorsTransitional ceil cancerSquamous cell cancer*. Smoking*. Chemical carcinogens: naphthylamine, benzidine, aniline*. Schistosomiasis (Bilharziasis)*. Long term use of analgesics*. Long time Cyclophosphamide exposure*. Pelvic irradiation*. Schistosomiasis (Bilharziasis)*. Chronic bladder infection*. Irradiation*. Bladder diverticulaCarcinoma in situ or Flat urothelial carcinoma - Pagetoid spread Staging and TreatmentSuperficial bladder cancers (does not invade the detrusor muscle)pTa - no lamina propria invasionpT1 - lamina propria invasionThe most common site of superficial tumors are the trigone and the lateral walls of bladder Clinical FeaturesPainless gross hematuria is the most common symptomFrequency, urgency and dysuria are common symptomsMetastasis: Most common primary to metastasize to penis - bladder cancerInvestigationsNew tests: Detection of antigens such as nuclear matrix proteins (NMP22) or mini-chromosome maintenance (MCM) in urine, which may be able to detect new or recurrent tumorsThe most common radiological sign is a filling defectFor staging contrast-CTMRI can demonstrate LN metastases and muscle invasionCystourethroscopy is the mainstay of diagnosisTreatmentSuperficial bladder cancersSolitary papillary lesions, no CIS: Endoscopic transurethral resection (TURT)CIS, recurrent disease, T1 disease, >40% bladder surface involvement: TURT followed by intravesical therapyStandard intravesical therapy: Bacille-Calmette-Guerin (BCG) 6 weeks instillations; followed by monthly instillations for 1 yearOther agents: Mitomycin C, interferon, gemcitabineFor persistent disease after BCG, immediate cystectomyMuscle invasion cancers (pT2-pT3): Radical cystectomy with pelvic lymphadenectomy; neo-adjuvant chemotherapy (M-VAC: Cisplatin, methotrexate, doxorubicin and vinblastine or GC: gemcitabine and cisplatin)
Category:
Surgery
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