Podcast
Questions and Answers
Which factor is NOT considered a risk factor for bladder cancer?
Which factor is NOT considered a risk factor for bladder cancer?
What distinguishes upper urinary tract (UUT) cancer from bladder cancer in terms of treatment?
What distinguishes upper urinary tract (UUT) cancer from bladder cancer in terms of treatment?
Which of the following treatments is considered a common strategy for bladder cancer?
Which of the following treatments is considered a common strategy for bladder cancer?
Which of the following statements about cancer cells is incorrect?
Which of the following statements about cancer cells is incorrect?
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What is the main type of cancer represented in about 93% of bladder cancer cases?
What is the main type of cancer represented in about 93% of bladder cancer cases?
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Which carcinogen is specifically associated with bladder cancer risk?
Which carcinogen is specifically associated with bladder cancer risk?
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At what age range does the peak incidence of bladder cancer occur?
At what age range does the peak incidence of bladder cancer occur?
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Which occupation is NOT listed as being at risk for chronic irritations related to bladder cancer?
Which occupation is NOT listed as being at risk for chronic irritations related to bladder cancer?
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Which type of hematuria suggests an initial urethral source?
Which type of hematuria suggests an initial urethral source?
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What percentage of patients with non-muscle invasive bladder cancer are likely to experience recurrence within 5 years?
What percentage of patients with non-muscle invasive bladder cancer are likely to experience recurrence within 5 years?
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Which diagnostic method is considered most effective for bladder cancer identification?
Which diagnostic method is considered most effective for bladder cancer identification?
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What is a common treatment option for patients diagnosed with high-grade bladder cancer?
What is a common treatment option for patients diagnosed with high-grade bladder cancer?
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Which surgical procedure is primarily used for muscle-invasive bladder cancer?
Which surgical procedure is primarily used for muscle-invasive bladder cancer?
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Which statement regarding upper urinary tract urothelial cancers is correct?
Which statement regarding upper urinary tract urothelial cancers is correct?
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Which treatment is NOT included for managing lymph node or distant metastases in bladder cancer?
Which treatment is NOT included for managing lymph node or distant metastases in bladder cancer?
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In staging bladder cancer, what percentage is considered muscle-invasive?
In staging bladder cancer, what percentage is considered muscle-invasive?
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What is the approximate percentage of patients with distant metastases at presentation?
What is the approximate percentage of patients with distant metastases at presentation?
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Which surgical approach is preferred for managing low-risk upper urinary tract cancer to reduce morbidity?
Which surgical approach is preferred for managing low-risk upper urinary tract cancer to reduce morbidity?
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What factor has NOT been established to support its introduction in daily clinical decision making for upper urinary tract cancer?
What factor has NOT been established to support its introduction in daily clinical decision making for upper urinary tract cancer?
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Which surgical method is associated with higher failure rates when segmental resection of the ureter is performed?
Which surgical method is associated with higher failure rates when segmental resection of the ureter is performed?
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What is a significant risk factor for tumor recurrence in the bladder related to upper urinary tract cancer?
What is a significant risk factor for tumor recurrence in the bladder related to upper urinary tract cancer?
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What is the sensitivity of MR urography for tumors smaller than 2 cm after contrast injection?
What is the sensitivity of MR urography for tumors smaller than 2 cm after contrast injection?
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Which diagnostic technique is considered the primary choice for staging lung and abdominal metastases?
Which diagnostic technique is considered the primary choice for staging lung and abdominal metastases?
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What is the role of urethrocystoscopy in the diagnosis of UTUC?
What is the role of urethrocystoscopy in the diagnosis of UTUC?
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What is the reported sensitivity of Barbotage cytology when taken from renal cavities and ureteral lumina?
What is the reported sensitivity of Barbotage cytology when taken from renal cavities and ureteral lumina?
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For the detection of nodal metastasis in surgically treated UTUC patients, which imaging technique has shown promising sensitivity?
For the detection of nodal metastasis in surgically treated UTUC patients, which imaging technique has shown promising sensitivity?
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Why should cytology be performed selectively for the affected upper tract in UTUC cases?
Why should cytology be performed selectively for the affected upper tract in UTUC cases?
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What is a possible outcome of employing novel imaging techniques and improved flexible ureteroscopes?
What is a possible outcome of employing novel imaging techniques and improved flexible ureteroscopes?
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What condition may be indicated by abnormal cytology when bladder cystoscopy appears normal?
What condition may be indicated by abnormal cytology when bladder cystoscopy appears normal?
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Which statement regarding the sensitivity of fluorescence in situ hybridization (FISH) is correct?
Which statement regarding the sensitivity of fluorescence in situ hybridization (FISH) is correct?
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What percentage of patients presenting with Upper Tract Urothelial Carcinomas (UTUCs) have invasive disease at diagnosis?
What percentage of patients presenting with Upper Tract Urothelial Carcinomas (UTUCs) have invasive disease at diagnosis?
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Which symptom is the most common in patients with Upper Urinary Tract Cancer?
Which symptom is the most common in patients with Upper Urinary Tract Cancer?
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What is the sensitivity of CT urography in diagnosing Upper Urinary Tract Cancer?
What is the sensitivity of CT urography in diagnosing Upper Urinary Tract Cancer?
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Which type of histological subtype is associated with chronic inflammatory diseases and infections due to urolithiasis in UTUC?
Which type of histological subtype is associated with chronic inflammatory diseases and infections due to urolithiasis in UTUC?
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What demographic is most commonly affected by Upper Urinary Tract Cancer?
What demographic is most commonly affected by Upper Urinary Tract Cancer?
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Which of the following factors is NOT associated with an increased risk of Upper Urinary Tract Cancer?
Which of the following factors is NOT associated with an increased risk of Upper Urinary Tract Cancer?
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What is the specificity of CT urography in diagnosing Upper Urinary Tract Cancers?
What is the specificity of CT urography in diagnosing Upper Urinary Tract Cancers?
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Which of the following symptoms should prompt an evaluation for metastases in patients with Upper Urinary Tract Cancer?
Which of the following symptoms should prompt an evaluation for metastases in patients with Upper Urinary Tract Cancer?
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What is the sensitivity of magnetic resonance urography for tumours smaller than 2 cm after contrast injection?
What is the sensitivity of magnetic resonance urography for tumours smaller than 2 cm after contrast injection?
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Which statement regarding the histological types of Upper Urinary Tract Cancers is true?
Which statement regarding the histological types of Upper Urinary Tract Cancers is true?
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Study Notes
Bladder and Upper Urinary Tract Cancers
- Bladder and upper urinary tract cancers are a significant urological concern.
- Learning outcomes include understanding risk factors, staging, treatment differences between bladder and upper urinary tract cancers, and treatment strategies.
- An overview of epidemiology, risk factors, evaluation, staging, grading, and current treatment strategies is provided.
Cancer Biology
- Cancer development proceeds through stages from normal tissue to hyperplasia to dysplasia to cancer.
- Cancer cells exhibit uncontrolled growth, lack programmed cell death response, invade tissues, and form new blood vessels (neovascularization).
- Cancer cells also can circumvent the immune system, and display genetic damage, and carcinogens can play a part as well.
DNA Structure
- DNA's structure is composed of nucleotides (guanine, cytosine, adenine, thymine).
- DNA is organized into chromosomes, histone, nucleosome, and genes.
- The cell cycle (G0, G1, S, G2, M) is highlighted.
How Does Cancer Form?
- Cancer cells form a mass distinct from normal cells.
- Cancer growth disrupts the normal tissue structure.
What Causes Cancer?
- DNA changes, specifically in genes, can cause cancer.
What Are Oncogenes?
- Oncogenes are genes that promote cell growth and division, and changes can cause cancer.
What Are Tumor Suppressor Genes?
- Tumor suppressor genes normally prevent excessive cell growth and division. Mutated tumor suppressor genes can cause cancer.
What Is the Tumor Microenvironment?
- The tumor microenvironment is the surrounding tissue that influences cancer development.
- Key components such as T cells, myeloid cells, macrophages, natural killer cells, and fibroblasts are part of the cellular composition of the tumor microenvironment.
How Does the Immune System Interact with Cancer?
- The immune system can attack cancer cells but can also be evaded by cancer cells.
What Causes Genetic Changes?
- Genetic changes in cancer can arise from heredity, viruses, UV radiation, smoking, chemicals, and cell division.
How Does Age Relate to Cancer?
- Age is a factor in cancer development.
What Is Metastasis?
- Metastasis involves the spread of cancer cells from the original tumor site to other parts of the body via the bloodstream.
Bladder Cancer
- Fourth most common cancer in men in 2014.
- 74,690 new cases and 15,580 deaths in 2014.
- Represents 7% of all cancers and 3% of all cancer deaths.
- Male to female ratio is 3:1.
- Peak incidence is between 60-70 years.
- Majority (~93%) are urothelial cancer (transitional cell carcinoma).
Bladder Cancer Risk Factors
- Exogenous factors include schistosomiasis, tobacco, cytostatics, sweeteners (saccharin, cyclamate), pelvic radiation, blackfoot disease, and chronic irritations.
- Endogenous factors include chronic inflammation with toxins (catheters) and conditions like
- Professions like dry cleaners, painters, autoworkers, truck drivers, paper manufacturers, metal workers, hairdressers, and tire, rubber, chemical and petroleum workers are at increased risk.
Symptoms and Signs
- Gross hematuria (visible blood in the urine) is the most common symptom (68-97%).
- Microhematuria (microscopic blood in the urine) occurs in 11% of cases.
- Hematuria timing can be initial, terminal, or continuous which can help identify its etiology.
- Irritative voiding symptoms (painful urination) and lumbar and suprapubic pain might also occur.
Diagnosis
- Cystoscopy is a common diagnostic procedure to examine the bladder.
- Urinary tumor markers (commonly cytology) can assist the diagnosis, and imaging techniques are employed extensively in diagnosis (Renal Ultrasound, IVP, CT Urogram, MR Urogram).
Staging
- 70% of bladder cancers are non-muscle invasive (superficial) and progress.
- 25% of cases are muscle-invasive.
- 5-year overall survival for muscle-invasive cancer is 78% (lower with node involvement).
- 5% are metastatic; chemotherapy can extend survival by 18 months;
Treatment and Prognosis
- Staging and grade factors influence treatment and prognosis.
- Factors including grade (low vs. high), tumor multiplicity, size of tumor, and whether invasive or not impacts prognosis.
- Up to 70% may recur in 5 years.
Surgical Therapies for Bladder Cancer
- Treatment strategies differ based on tumor stage and grade.
- Surgical therapies include transurethral resection of the bladder tumor (TURBT), intravesical therapy, radical cystectomy, and urinary diversion.
- Trimodal therapy combines radiation, chemotherapy, and surgery.
- Robotic approaches include partial and radical cystectomy.
Upper Urinary Tract Cancer
- Upper urinary tract cancers (UTUC) are less common than bladder cancer (5-10% of all cases).
- Patients are predominantly male (70.5%).
- Approximately 53.3% are ex-smokers or current smokers; about 58% present with symptoms, mostly hematuria.
- Cancer history in the bladder increases risk of developing UTUC.
Upper Urinary Tract Cancer Risk Factors
- Etiology of cancer can involve genetic predisposition, tobacco exposure, arsenic in drinking water, aristolochic acid from plants (and various others).
Upper Urinary Tract Cancer Histological Types
- Histologically, most UTUCs are urothelial cancers.
- In 15% of cases, UTUCs have a divergent squamous differentiation.
- Keratinizing squamous metaplasia can increase the risk of squamous cell cancers.
- Other rare subtypes include sarcomatoid and inverted growth.
Upper Urinary Tract Cancer Symptoms
- Visible or nonvisible hematuria is common in patients (70–80%).
- Flank pain (from clot or tumor) occurs in 20–32% of cases.
- Systemic symptoms (e.g., anorexia, weight loss) sometimes occur, and should signal evaluation for metastasis
Upper Urinary Tract Cancer Diagnosis
- CT urography is a primary diagnostic method owing to its high sensitivity and specificity (92% and 95% respectively).
- Other diagnostic tools include MR urography, 18F-FDG PET/CT.
- Urethrocystoscopy is an essential part of diagnosis to rule out complications and other possible issues.
Upper Urinary Tract Cancer Treatment/Management
- Patients with low-risk cancers often get kidney-sparing approaches for surgery, like flexible ureteroscopy or laparoscopic procedures.
- However, high-risk cancers necessitate radical nephroureterectomy and template lymphadenectomy.
- Staging of the cancer is essential prior to treatment.
Additional Information
- Prognostic factors exist, dividing into patient (age/ethnicity) and tumor characteristics (size, location) and can be utilized in evaluating and deciding treatment options to lower risk of recurrence or improve results.
- Molecular markers can be useful in diagnosis and treatment decisions, but retrospective and small sample size can affect use.
- Kidney-sparing surgery can help with low-risk UTUC.
- The use of a lymph node template during lymphadenectomy can enhance survival.
- Cisplatin-based neoadjuvant chemotherapy can be employed in UTUC patients.
- Immunotherapy options like nivolumab, avelumab, and durvalumab may be incorporated into treatment for specific cases of UTUC.
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Description
This quiz explores bladder and upper urinary tract cancers, focusing on risk factors, staging, and treatment strategies. Gain an understanding of cancer biology and DNA structure as they relate to these cancers. Test your knowledge on how these elements interact in the context of urological health.
