Malignant tumor of urinary bladder - Chronic
Definition
Primary malignancy of the urinary bladder including transitional cell carcinomas (90%), squamous cell carcinomas (3% to 7%), and adenocarcinomas (2%)
Suspected and known bladder cancer
* Endoscopy of bladder: Cystoscopy is indicated as part of the initial workup in suspected bladder cancer and for surveillance after treatment of known bladder cancer .
Complete Cystectomy
Suspected and known bladder cancer
* Urine cytology: Abnormal cytology results are suggestive of bladder cancer; definitive diagnosis requires histological examination of pathologic tissue .
Bladder cancer surveillance
* Hepatic function panel
* Plasma creatinine measurement
* Blood electrolyte measurement
* Plain chest X-ray
B12 deficiency monitoring in patients who have had a continent diversion
* Serum vitamin B12 measurement
Medical History
* Smoking
* Occupational Exposure
* Urinary tract infection, chronic
* Insertion of indwelling catheter
* Urinary bladder stone
* Radiation therapy
* Cyclophosphamide use
* Schistosomiasis
* History of Phenacetin use
* Arsenic toxicity
* Family history of Malignant tumor of urinary bladder
Findings
* Hematuria
* Bladder irritability
* Dysuria
* Increased frequency of urination
* Urgent desire to urinate
Tests
Suspected and known bladder cancer
* Endoscopy of bladder: Cystoscopy is indicated as part of the initial workup in suspected bladder cancer and for surveillance after treatment of known bladder cancer .
Suspected and known bladder cancer
* Urine cytology: Abnormal cytology results are suggestive of bladder cancer; definitive diagnosis requires histological examination of pathologic tissue .
Suspected and known bladder cancer .
* Transurethral resection of bladder neoplasm: Transurethral resection of bladder tumor allows for specimen retrieval and tumor excision .
* Bimanual examination: Tumor size and depth of penetration can be gauged with a bimanual examination under anesthesia before and after endoscopic surgery .
Initial workup and regular follow-up of certain tumor types
* Abdominal contrast procedure: Intravenous pyelogram, CT urography, renal ultrasound with retrograde pyelogram, or MRI urogram is indicated if the initial cystoscopy shows noninvasive or muscle invasive disease .
Suspected metastatic disease or cystoscopic or pathologic evidence of sessile, high-grade, or muscle invasive disease .
* CT of abdomen and pelvis: CT scanning is not recommended for the routine workup for bladder cancer but is indicated for suspected metastasis and cystoscopic or pathologic evidence of sessile, high-grade, or muscle-invasive disease .
Suspected metastatic bladder cancer
* Plain chest X-ray
* Hepatic function panel
* Serum alkaline phosphatase measurement
* Radioisotope scan of bone
Differential Diagnosis
* Transitional cell carcinoma of bladder
* Squamous cell carcinoma of bladder
* Adenocarcinoma of bladder
* Micropapillary transitional cell carcinoma of bladder
* Small cell carcinoma of bladder
* Sarcoma of bladder
* Malignant lymphoma
* Nephrogenic adenoma
* Cystitis cystica
Treatment
Drug Therapy
Intravesical treatment of bladder cancer
BACILLUS OF CALMETTE AND GUERIN VACCINE, LIVE
MITOMYCIN
THIOTEPA
DOXORUBICIN HYDROCHLORIDE
EPIRUBICIN HYDROCHLORIDE
VALRUBICIN
INTERFERON ALFA-2B
Metastatic bladder cancer
GEMCITABINE HYDROCHLORIDE - CISPLATIN
METHOTREXATE SODIUM - VINBLASTINE SULFATE - DOXORUBICIN HYDROCHLORIDE - CISPLATIN
Procedural Therapy
Suspected and known bladder cancer .
* Transurethral resection of bladder neoplasm: Transurethral resection of bladder tumor allows for specimen retrieval and tumor excision .
Select patients with bladder cancer including most patients with muscle invasive disease
* Bladder excision: Radical cystectomy is recommended for most patients with resectable muscle invasive disease and some patients with nonmuscle invasive disease and recurrence after intravesical therapy .
Selected patients with bladder cancer
* Radiation therapy: Radiation therapy may be used as part of a bladder sparing approach in muscle invasive disease or as part of palliative therapy .
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