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Bladder cancer: Difference between revisions
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<section begin="pathology" /><section begin="radiology" />'''Bladder cancer''' is the most common cancer of the urinary system. The most common histological type is urothelial carcinoma, previously called transitional cell carcinoma (90% of cases). The remaining cases are squamous cell carcinoma and adenocarcinoma.<section end="radiology" /> | <section begin="oncology" /><section begin="pathology" /><section begin="radiology" />'''Bladder cancer''' is the most common cancer of the urinary system. The most common histological type is urothelial carcinoma, previously called transitional cell carcinoma (90% of cases). The remaining cases are squamous cell carcinoma and adenocarcinoma.<section end="radiology" /> | ||
Urothelial carcinoma can occur anywhere there is urothelium, although it occurs most commonly in the bladder and renal pelvis and more rarely in the ureters and urethra. It's usually asymptomatic in early stages, and the most common presenting symptom is painless gross haematuria, which is present in 80% of bladder cancer patients. | Urothelial carcinoma can occur anywhere there is urothelium, although it occurs most commonly in the bladder and renal pelvis and more rarely in the ureters and urethra. It's usually asymptomatic in early stages, and the most common presenting symptom is painless gross haematuria, which is present in 80% of bladder cancer patients. | ||
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== Pathology == | == Pathology == | ||
90% of bladder cancer cases are urothelial carcinoma, previously called transitional cell carcinoma. | 90% of bladder cancer cases are urothelial carcinoma, previously called transitional cell carcinoma. | ||
<section end="oncology" /> | |||
=== Classification === | === Classification === | ||
The new WHO classification of urothelial carcinoma distinguishes between flat and papillary urothelial lesions: | The new WHO classification of urothelial carcinoma distinguishes between flat and papillary urothelial lesions: | ||
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Less than 10% of low-grade cancers invade, but as many as 80% of high-grade cancers do. Invasion majorly affects the prognosis; 5-year survival is 90% in non-invasive cancer but only 10% in invasive cancer. The degree of which the urothelial tumor has invaded the bladder wall is important in the prognosis. Invasive tumors may extend not only into the bladder wall but to adjacent structures like the prostate, seminal vesicles, ureters and retroperitoneum. Haematogenous dissemination usually involves the liver, lungs and bone marrow. | Less than 10% of low-grade cancers invade, but as many as 80% of high-grade cancers do. Invasion majorly affects the prognosis; 5-year survival is 90% in non-invasive cancer but only 10% in invasive cancer. The degree of which the urothelial tumor has invaded the bladder wall is important in the prognosis. Invasive tumors may extend not only into the bladder wall but to adjacent structures like the prostate, seminal vesicles, ureters and retroperitoneum. Haematogenous dissemination usually involves the liver, lungs and bone marrow. | ||
<section begin="oncology" /> | |||
=== Polychronotropy === | === Polychronotropy === | ||
Urothelial carcinoma shows ''polychronotropy'', which means that when one urothelial carcinoma is found it is very likely that other urothelial tumors are present or currently developing at other places of the mucous membrane. Because of this, urothelial carcinoma has a high risk of recurrence. | Urothelial carcinoma shows ''polychronotropy'', which means that when one urothelial carcinoma is found it is very likely that other urothelial tumors are present or currently developing at other places of the mucous membrane. Because of this, urothelial carcinoma has a high risk of recurrence. | ||
<section end="oncology" /> | |||
=== Pathogenesis === | === Pathogenesis === | ||
Carcinogenesis involves deletions of tumor-suppressor genes on chromosome 9p or 9q. The p16 or p53 genes are commonly involved. | Carcinogenesis involves deletions of tumor-suppressor genes on chromosome 9p or 9q. The p16 or p53 genes are commonly involved. | ||
<section begin="oncology" /> | |||
=== Other histological types === | === Other histological types === | ||
Adenocarcinoma is rare and histologically identical to gastrointestinal adenocarcinomas. | Adenocarcinoma is rare and histologically identical to gastrointestinal adenocarcinomas. | ||
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=== Radiotherapy === | === Radiotherapy === | ||
Radiotherapy may be part of bladder preservation therapy or be used palliatively for metastatic disease.< | Radiotherapy may be part of bladder preservation therapy or be used palliatively for metastatic disease.<section end="oncology" /> | ||
[[Category:Urology]] | [[Category:Urology]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||