Urology Book

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Urinary Bladder Disorders

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Bladder Cancer

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  1. Epidemiology
    1. Incidence in United States
      1. New cases in 1996: 52,900 (fifth most common cancer)
      2. Deaths in 1996: 11,700 (12th cause of cancer death)
    2. Men affected more than women by ratio of 3:1
  2. Risk Factors (latency of 5 to 50 years after exposure)
    1. Tobacco abuse (2-5 fold dose dependent risk)
    2. Occupational exposure to aromatic amines
      1. Industries
        1. Textile industry
        2. Leather industry
        3. Rubber manufacturing
        4. Paint and Dye manufacturers
        5. Hairdressing chemicals
        6. Organic chemical industries
      2. Compounds
        1. Beta-naphthyl amines
        2. Xenylamine
        3. 4-nitrobiphenyl
        4. Benzidine
  3. Symptoms
    1. Painless, microscopic or Gross Hematuria (80%)
    2. Irritative voiding symptoms (20%)
      1. Urinary Frequency
      2. Urinary Urgency
      3. Dysuria
  4. Differential Diagnosis
    1. Nephrolithiasis
    2. Renal Cancer
    3. Cystitis
  5. Diagnostics
    1. Urine Cytology
      1. Smear of exfoliated urinary cells
      2. Test Sensitivity for bladder cancer
        1. Overall: <75%
        2. High grade lesions: >80%
        3. Immunocytology: 70-90%
          1. Nuclear matrix protein (bladder Tumor Marker)
        4. Associated with flow cytometry: 93%
    2. Cystoscopy (gold standard)
  6. Radiology
    1. Intravenous pyelogram
  7. Staging
    1. See Bladder Cancer Staging
  8. Management: Superficial Bladder Cancer (Tis, Ta, T1)
    1. Small, solitary low grade mucosal diploid tumors (Ta)
      1. Low risk or recurrence
      2. Transurethral resection
      3. Surveillance for recurrence
    2. Multifocal, high grade aneuploid tumors (Tis or T1)
      1. Transurethral resection and
      2. Intravesical Immunotherapy 2 hours/week for 6-8 weeks
        1. Bacillus Calmette Guerin (BCG)
        2. Mitomycin
        3. Doxorubicin
        4. Thiopeta
  9. Management: Invasive Bladder Cancer (T1 to T4)
    1. External Beam Bladder Irradiation
    2. Systemic Chemotherapy
      1. Methotrexate
      2. Vinblastine sulfate
      3. Adriamycin
      4. Cisplatinum
    3. Partial Cystectomy
    4. Radical cystectomy with pelvic lymphadenectomy
  10. Management: Metastatic Bladder Cancer
    1. Chemotherapy protocol: M-VAC
      1. Methotrexate
      2. Vinblastine sulfate
      3. Adriamycin
      4. Cisplatinum
    2. Chemotherapy protocol: Experimental
      1. Paclitaxel alone
    3. Chemotherapy protocol: Experimental
      1. Gallium nitrate
      2. Vinblastine
      3. Ifosfamide
  11. Prognosis
    1. Worse outcomes for patients continuing Tobacco abuse
      1. Fleshner (1999) Cancer 86:2337
    2. Metastatic Bladder cancer (untreated)
      1. Two year survival: <5%
  12. References
    1. Badalament (1996) Postgrad Med 100(2):217
    2. Lamm (1996) CA Cancer J Clin 46(2):93

Malignant neoplasm of urinary bladder (C0005684)

Definition (NCI)A primary or metastatic malignant neoplasm involving the bladder. - 2003
ConceptsNeoplastic Process (T191)
ICD9188, 188.9
MSHD001749
DanishOndartet svulst urinblaere
DutchMaligne neoplasma blaas
EnglishBladder Ca, BLADDER CANCER, Bladder Cancers, CA - Bladder cancer, Cancer of Bladder, cancer of the bladder, Malignant Bladder Neoplasm, Malignant Bladder Tumor, Malignant neoplasm of bladder, Malignant Neoplasm of the Bladder, Malignant Neoplasm of the Urinary Bladder, Malignant neoplasm of urinary bladder, Malignant Tumor of Bladder, Malignant Tumor of the Bladder, Malignant Tumor of the Urinary Bladder, Malignant tumor of urinary bladder, Malignant tumour of urinary bladder, Malignant Urinary Bladder Neoplasm, Malignant Urinary Bladder Tumor, urinary bladder cancer, Urinary Bladder Malignant Neoplasm, Urinary Bladder Malignant Tumor
FinnishRAKON PAHANLAATUINEN KASVAIN
FrenchCancer vessie
Germanboesartige Neubildung der Blase
Hebrewsartan kis hasheten
Hungarianhugyholyag malignus tumora
ItalianNeoplasie maligne della vescica
NorwegianONDARTET SVULST URINBLAERE
PortugueseNeoplasia maligna da bexiga
Spanishneoplasia maligna de la vejiga, neoplasia vesical maligna, tumor maligno de vejiga
SwedishMALIGN BLASTUMOR
Parent ConceptsCancer of Urinary Tract (C0751571), Malignant neoplasm of urinary organ, unspecified (C0348371), Malignant neoplasm of urinary bladder (C0005684), Malignant neoplasm of genitourinary organ NOS (C0178251), urology (C0042077), Diagnosis/Diseases Component (C0497531), Bladder Neoplasm (C0005695), kidney/urinary cancer (C0279521), adult solid tumor (C0280099), Malignant neoplasm of abdomen (C0153662), Ambiguous concept (C1274012)
SourcesAOD, CCS, CSP, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, MEDLINEPLUS, MSH, MTH, NCI, OMIM, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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