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| Common symptoms of cystitis are urgency, lower abdominal pain and dysuria. | | Common symptoms of cystitis are urgency, lower abdominal pain and dysuria. |
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| == Urothelial carcinoma == | | = Bladder cancer = |
| The most common urinary bladder neoplasm by far is the urothelial carcinoma (90% of cases), however squamous cell carcinoma and adenocarcinoma exist.
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| 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. 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.
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| Urothelial carcinoma is the second most frequent cancer in smokers, after lung cancer of course. This is because the urothelium is exposed to the toxins in the cigarette smoke after it has been excreted by the kidney. It’s also associated with occupational toxins, cyclophosphamide, analgesics and schistosome (parasitic) infection.
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| Carcinogenesis involves deletions of tumor-suppressor genes on chromosome 9p or 9q. The p16 or p53 genes are commonly involved.
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| Most patients are older men between 50 and 80 years. It usually presents with painless haematuria. If the tumor is at the ureteric orifice can hydronephrosis occur.
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| The new WHO classification of urothelial carcinoma distinguishes between flat and papillary urothelial lesions:
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| * Flat lesions
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| ** Urothelial dysplasia
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| ** Urothelial carcinoma in situ – flat carcinoma
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| * Papillary lesions
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| ** Urothelial papilloma – exophytic growth with normal-looking urothelium
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| ** Urothelial neoplasm of low malignant potential – similar to papilloma but thicker urothelium
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| ** Low grade papillary urothelial carcinoma – minimal atypia. retained polarity of cells.
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| ** High grade papillary urothelial carcinoma – high atypia. loss of polarity.
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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.
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| Therapy may include:
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| * BCG – a non-viral strain of mycobacterium tuberculosis which is introduced into the tumor. This activates the immune system which targets the cancer cells.
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| * TUR – TransUrethral Resection of the tumor
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| * Radical cystectomy
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| Squamous cell carcinoma is associated with urinary schistosomiasis (specially in endemic countries like Egypt), chronic bladder irritation and infection.
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| Adenocarcinoma is rare and histologically identical to gastrointestinal adenocarcinomas.
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| [[Category:Pathology 2 - Theoretical exam topics]] | | [[Category:Pathology 2 - Theoretical exam topics]] |