Bladder Neoplasms

Bladder neoplasms: >90% arise from transitional epithelium (most are malignant); bladder carcinomas clinically features:

• Painless hematuria

• Frequency, urgency, dysuria (urinary symptoms)

• Later pyelonephritic complications

Majority of urothelial cancers are caused by exposure to environmental agents; therefore bladder tumours are usually multiple and often found in conjunction with urothelial tumours at other sites of lower urinary tract (e.g. renal pelvis, ureters or urethra).

Aetiology: frequently multifactorial…

• Chemicals: exposure to environmental agents excreted in high concentrations in the urine e.g. cigarette smoking (direct carcinogen, aberrant tryptophan metabolism and toxic metabolites), aniline dyes, rubber etc (many associated with certain industrial occupation)

• Premalignant conditions: e.g. bladder diverticular (3% complicated with tumour), schistosomiasis (esp. SCC)

Other possible factors include: diets high in fat or protein, cyclophosphamide exposure, genetic abnormalities and analgesic abuse.

Clinical course:

All (high grade more than low grade) have a tendency to recur; may be in different sites and tend to exhibit greater anaplasia

Prognosis related to histological type, growth pattern, grade, and stage; other factors e.g. p53, c-myc expression, HCG production, karyotype etc.

Death may be due to renal failure (obstruction and infection) and disseminated carcinoma (direct, lymphatic or haematogenous).

Category: Surgery Notes