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 Bladder Cancer

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تاريخ التسجيل : 02/04/2008

مُساهمةموضوع: Bladder Cancer   الثلاثاء 08 أبريل 2008, 19:30

Bladder Cancer

--Transitional cell carcinomas account for
90% of all bladder cancers, while squamous cell tumors and adenocarcinomas
account for the remaining 10%.


Causes and Incidence Known carcinogens
include tobacco tars and industrial chemical agents found in many rubber, dye,
and chemical manufacturing plants, petrochemical plants, printing plants, and
paint shops. Chronic irritants (e.g., schistosomiasis, bladder calculi) are
predisposing factors. More than 51,600 new cases are diagnosed each year in the
United States, and the incidence is three times higher for men.


Disease
Process Transitional cell tumors are characterized by multicentric and papillary
growth into the bladder lumen, with potential invasion into the bladder muscle,
pelvis, pelvic structures, and surrounding lymph nodes. The lungs, bones, and
liver are common sites of metastasis.


Symptoms Frequency of and burning
on urination, hematuria, dysuria, and pyuria are the most common presenting
signs and symptoms. Pain in the legs, pelvis, and lower back may develop with
invasion and metastasis.


Potential Complications Fistulas of the ureter
or small bowel (or both) and obstruction of the small bowel are possible.


Diagnostic Tests Filling defects on a cystogram and positive results on
urine cytologic tests suggest a neoplasm. The definitive diagnosis is made by
cystoscopy and transurethral resectional biopsy. Computed tomography or magnetic
resonance imaging with bimanual examination is used forstaging.


Treatments

Surgery
Noninvasive tumors: endoscopy and
fulguration; laser therapy for noninvasive tumors Invasive tumors: radical
cystectomy with urinary diversion


Drugs
Chemotherapy: Noninvasive
tumors: intravesical instillations with bacille CalmetteGue?rin (BCG),
doxorubicin, thiotepa or mitomycin-C for noninvasive tumors Invasive tumors:
systemic chemotherapy with multidrug combinations such as cisplatin,
methotrexate, doxorubicin, and vinblastine (CMDV), or methotrexate, vinblastine,
and cisplatin (MVC)


General
Radiation as a preoperative regimen or
as adjunct to chemotherapy; care of and instruction about ileal
appliance


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Bladder Cancer
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