2. Dr. Abdellatif Zayed Amzayed_1919@yahoo.com Bladder Cancer

3.  Predisposing Factors  Pathologic Types  Staging  Grading  spread Pathology: Management: Clinical featuresClinical features InvestigationsInvestigations treatmenttreatment Today Objectives

4. Predisposing factors: 1. Industrial toxins 2. Drugs: e.g. Cyclophosphamide

5. Predisposing factors:  Bilharzial infestation

6. 1.Transitional cell carcinoma: The commonest 2.Squmous cell carcinoma: In Egypt 50%. 3.Adinocarcinoma: bladder extrophy 4.Undifferentiated tumor: Highly aggressive. Pathologic Types:

7. Layers of the bladder wall

8.  Tis: Carcinoma in situ  Ta: Nan invasive papillary  T1: Invade subepithelial  T2: Invades muscle  T3: Invades perivesical t.  T4: Invades adjacent org. Stages

9. Tis: Carcinoma in situ Ta: Nan invas. papillary T1: Invade subepithelial T2: Invade muscle T3: Invade perivesical t. T4: Invade adjacent org. Staging

10. Staging

11. Clinical Features:  Hematuria  Irritative symptoms  Necroturia

12.  Urine analysis and urine cytology  Ultrasound examination  IVU and CT  Cystoscopy and biopsy Investigations

13. Ultrasound Pictures

14. Cystogram DD Bladder mass Bladder mass Blood clots Blood clots Prostatic enlargement Prostatic enlargement Fungus ball Fungus ball

15.  The primary imaging modality in evaluation of bladder tumor. CT scan

17. MRI has higher soft-tissue contrast than CT MRI has higher soft-tissue contrast than CT MRI

21. Ta: Cystoscopic View of Papillary T

22. Tis: Carcinoma in situ

23. Treatment of superficial bladder CA  Complete TUR-T and immediate single intravesical instillation chemotherapy  Adjuvant intravesical immunotherapy: BCG  Radical cystectomy for certain cases.

24. Follow up is essential

25. Operable: Radical cystectomy and urine diversion Treatment of invasive tumor

26. Inoperable: palliative radiotherapy

27. Continent: Continent: –Orthotopic bladder substitution –Continent reservoir for CIC –Ureterosigmoidostomy Non Continent: Non Continent: - Uretero- cutaneous diversion - Uretero- cutaneous diversion - Ileal conduit - Ileal conduit Urine Diversion

28. depends on the intact urethra and sphincter to carry urine to the urethral meatus. depends on the intact urethra and sphincter to carry urine to the urethral meatus. In case the urethra is involved by cancer, a continent reservoir with self catheterizable stoma. In case the urethra is involved by cancer, a continent reservoir with self catheterizable stoma. Orthotopic Neobladder

29. Orthotopic Ileal neobladder

30. Ileal orthotopic neobladder Voiding cystourethrogram

31. 3 Dimensions CT (Ilial neobladder)

32.  Hyper continence  Stone  Metabolic acidosis Complications

33. Ureterosigmoidostomy

34.  Ascending infection  Hypercholorimic acidosis  Adenocarcinoma Complications

35. Ilial Conduit

36. 3 D. CT (Ilial Conduit)

37. (1) stomal :  Necrosis  Stenosis  Hernia (2) peristomal:  Fungal dermatitis  Contact dermatitis.  Trauma Complications

38. Rarely done because of complications:  Urine leakage.  Infections.  Stenosis. Uretero Cutaneous Diversions

39. Regarding bladder tumors, all are true except: a. 90% are squamous carcinomas b. Painless haematuria is the commonest presentation c. Cigarette smoking is an important etiological factor d. Superficial tumors are often well controlled by TUR

40. Smoking increases the risk of : a. Oro-pharyngeal carcinoma b. Lung cancer c. Carcinoma of bladder d. All of the above

41. Pathology of schistosomiasis may include a. ”Swimmers itch” caused by skin penetration by cercariae b. Portal hypertension due to fibrosis c. Pre-disposition to bladder cancer d. All of the above

42. Female Anatomy

43. Male Anatomy Male Anatomy

44. Thank you Amzayed_1919@yahoo.com  0101953318