bladder and renal carcinoma power point

what is the 4th prevalent cancer in men

bladder

bladder cancer is _ more often in men than women

3x

bladder cancer is _ more often in whites than blacks

2x

what is the average age of bladder cancer

73 years

what continues to increase in bladder cancer

incidence

what can increase the risk of bladder cancer 60x more in a pt

aniline dye industry or toxic chemicals

what does aniline dye industry result in

workers manufacturing rubber, furniture, textiles, leather, paint, chemicals, and petroleum

what offers 6x higher incidence of bladder cancer

smoking/tobacco

what causes up to 60% of all bladder cancers

smoking

smoking is said to cause up to _% of all bladder cancers

60%

what is the average interval form exposure of smoking to diagnosis of bladder cancer

20 years

what helps prevent bladder cancer by flushing out carcinogens

generous fluid intake

what are the most important prognostic factors of bladder cancer

tumor extent and depth of muscle invasion

what are other prognostic indicators of bladder cancer that are important but less important than tumor extent and depth of muscle invasion

pathology and degree of differentiation

where does the urinary bladder lie when it is empty

within true pelvis

what does tetrahedral mean

4 sides

how many sides does the empty bladder have

4

how is each side of an empty bladder shaped

like a triangle

what is the superior surface of the bladder covered in

peritoneum

where is the base of the bladder located 

behind peritoneum

where is the apex of the bladder located 

in front of peritoneum

where is the apex of the bladder tilted toward

the upper part of the pubic symphysis

what joins the apex of the bladder to the umbilicus

umbilical ligament

where does the bladder lie without any intervening peritoneum

anterior abdominal wall

what two things rest on the superior surface for males

sigmoid colon and coils of small intestine

what pierce the base of the bladder obliquely on each side of the posterior base

ureters

what composes the trigone

openings of the ureters and urethra orifice

how big are the sides of the trigone in the contracted state

2.5 cm

how big are the sides of the trigone in the distended state

5cm

where does the bladder neck sit in males

prostate

what are located at the posterior superior aspect of the prostate gland

seminal vesicles and vas deferens

what separates lowest part of bladder from rectum

neck of bladder

what kind of cells make up the epithelium of the bladder

transitional cells

where is mucous membrane loosely attached to in the epithelium of bladder

trigone

what is the most common site of bladder cancer

lateral or posterior walls

where is the second most common site of bladder cancer

trigone

what is the lymphatic spread for bladder cancer

internal iliac, external iliac, common iliac, and paraaortic nodes

what percent of pts present with gross, painless hematuria in bladder cancer

80%

what do 80% of bladder cancer pts present with 

gross, painless hematuria

when pts are getting painless hematuria, is it fast pace or intermittent

intermittent

what are some bladder irritation symptoms a bladder cancer pt can have

frequency, urgency, dysuria, and hematuria

what is the list of how to detect and diagnose bladder cancer

urinalysis, CBC with liver function test, cystoscopic exam, CT or MRI, bimanual exam under anesthesia, bone scan

what does a CT or MRI do for detecting bladder cancer

evaluates bladder wall thickness and lymph node status

what is a bone scan used for in bladder cancer

advanced disease or to evaluate bone pain

what is the most common pathology in bladder cancer (92%)

transitional cell carcinoma

what percent of bladder cancer is transitional cell carcinoma

92%

what pathology is the worst prognosis in bladder cancer

non-transitional cell 

how do you describe squamous cells

flat, overlapping, scaly looking cells of epithelia surfaces

how do you describe transitional cells

intermediate height, transitional epithelial cells

how do you describe columnar cells

tall epithelial cells

how do tumors appear in the bladder

papillary (nipple shaped)

what kind of pts are linked to higher risk of their cancer in the bladder being squamous

chronically irritated bladders

why can pts have a chronically irritated bladders

from long-term catheters use or bladder calculi

what percent of pts with superficial bladder cancer have Tis-T1

80%

what percent of pts have muscle invasion at the time of their bladder cancer diagnosis

20%

what stage is muscle invasion at the time of diagnosis

T2-T4

with pts with bladder cancer, what is highly malignant and aggressive that can involve multiple sites in bladder 

carcinoma in situ

what kind of cells are thin and flat, scale like

squamous

what do squamous cells line in the body

mouth, blood vessels, heart and lungs, and make up outer layer of slin

where do simple columnar epithelium cells line in the body

line stomach and intestine

what shape is simple columnar epithelium

column shaped

where do transitional epithelial cells originate

kidney, bladder, or ureter only

how is the shape of transitional epithelial cells

shape can vary when stretched out

what is the spread of bladder cancer

direct extension into or through the wall of the bladder

where may bladder cancer spread

along surface or into prostatic urethra, or into ureters

where does the lymphatic drainage go in bladder cancer

external iliac and internal iliac lymph nodes

what is the risk of lymphatic spread related too in bladder cancer

depth of tumor invasion in the bladder wall

where is the most common mets sites in bladder cancer

lung, bone, and liver

what is the treatment in north america how do they treat muscle-invasive bladder and trigone-involved cancer

cystectomy and pelvic lymphadenectomy

what is the survival result does a cystectomy and pelvic lymphadenectomy have

80% 5 year survival

what is removed in men when a cystectomy and pelvic lymphadenectomy

nodes, bladder and prostate

what is removed in women when a cystectomy and pelvic lymphadenectomy

nodes, bladder, urethra, anterior vagina and uterus

where are two different areas that have greatly enhanced pt satisfaction with radical surgery, and helped pt avoid external collecting devices

pouch from ileum and pouch from colon

what is an illeal conduit urinary diversion

last section of the small used to make pouch to be used for a reservoir for the bladder

what is done to the end of ilium in an illeal conduit urinary diversion

it is pulled out of abdominal wall to make a stoma

is an illeal conduit a simple or hard surgery

simple

what is used to drain the urine in an ileal conduit

tube

what is done so the pt can expel urine in ileal conduit

pt will wear an external bag to collect urine

what is a complication that causes some pts to have frequent infections with an ileal conduit

reflux of urine

what is the pouch made up of in an indiana pouch

it is made from small and large bowel

what can the indiana pouch provide

a built in “stop valve”

what is the size of the stoma for the indiana pouch

very small

describe an indiana pouch reservior

one way valve that is surgically created to keep urine in pouch until accessed 

what will a patient do every 4 hrs if they have an indiana pouch reservior

insert a small catheter that opens valve and drains urine

is an external bag needed in an indiana pouch reservoir

no

is the surgery simple or complicated in an indiana pouch reservior

complicated

what is the pros of an indiana pouch reservoir

less risk of reflux, so less risk infection

how are lesions treated that are smaller than 5cm without involving trigone in bladder cancer

transurethral resection via electrofulguration followed by intravesical chemo or immunotherapy

what is an electrofulguration

removes bladder cancer cells

what is BCG used for

to prevent recurrence

what is the first line of treatment with a lesion smaller than 5cm in bladder cancer

intravesical chemo

when should BCG be adminstered

after about a 2 week delay after transurethral resection

what is a BCG diluted with and instilled by

saline and instilled by gravity flow into the bladder through a small catheter

how long is a pt asked to retain BCG instillation

two hours

how long is BCG treatment given

once a week for 6 weeks

what does BCG treatment give for the pt

good long term protection from tumor recurrence and progression

what kind of therapy may be done in a series of 3 installations at specified intervals

maintenance therapy

what does maintenance therapy help with for the pt

recurrence

what is the second line of tx for bladder cancer

maintenance therapy 

what is the majority of bladder cancer pathology

superficial