Bladder Cancer Overview

Bladder Cancer

• Incidence: 4% of solid tumors, with a ratio of 2.5:1 for males to females
• Risk factors:
  • Industrial chemicals (e.g., synthetic dyes) increase risk by 30%
  • Smoking (85% of smoker patients)
  • Schistosoma haemotobium infection (epidemic in Africa)
  • Certain medications (e.g., cyclophosphamide, phenacetin, cyclamate)
  • Abnormal metabolism of tryptophan (up to 50% of patients)
• Pathological anatomy:
  • 90% transitional carcinomas
  • 8% carcinoame squamous cells
  • Adenocarcinoma, sarcomas (rare)
  • Frequently found in the rear and side walls of the bladder
  • Multiple urothelial localizations (25% of cases)
• Natural history:
  • In situ carcinoma is multifocal, recurrent, and has an 80% progression rate
  • Superficial tumors (G1) have a good prognosis
  • Infiltrative tumors (G2-G3) are aggressive and have a poor prognosis
• Prognostic factors:
  • Depth of invasion (pT)
  • Histological type (e.g., spinocellular)
  • In situ carcinoma (80% progression rate)
  • Degree of tumor mast
  • ABO blood group antigens (_loss of antigens indicates invasion)

Breast Cancer

• Risk factors:
  • Genetic factors (e.g., BRCA-1, BRCA-2 genes)
  • Maternal breast cancer history
  • C-erbB2-neu amplification and EGFR2 expression
• Diagnostic factors:
  • First symptom (99% of cases are symptomatic)
  • Tumor (90% of cases)
  • Pain (8% of cases)
  • Mammillary secretion (4-7% of cases)
  • Tegument retraction (less than 1% of cases)
  • Adenopathy (2-30% of cases)
• Histopathological factors:
  • Dimensions of the tumor
  • Histological type
  • Histoprognostic grade (SBR)
  • Stromal reaction
  • Tumor emboli
  • Loco-regional lymph node extension

Lung Cancer

• Anatomopathological correlations:
  • Squamous cell carcinoma (40-50% of cases) is often hilar in location
  • Adenocarcinoma (35-40% of cases) is often peripheral in location
  • Small cell carcinoma (15-20% of cases) is often mediastinal in location
• Prognostic factors:
  • Histological type
  • Clinical status
  • Performance status
  • Weight loss
  • Operability
  • Response to first treatment

Cervix Cancer

• Epidemiology:
  • 4th place of female cancer mortality
  • Incidence of 13.3% among the largest in the world
  • Maximum frequency among women aged 50-59 years
• Etiology:
  • Venereal diseases (e.g., gonorrhea, trichomonas, syphilis, chlamydia)
  • Viral infections (e.g., herpes simplex, HPV) associated with 90% of cases
• Prophylaxis:
  • Primary: elimination of risk factors
  • Secondary: screening (at 3 years) for women aged 60 and above
  • Yearly screening for women aged 30 and above with dysplasia

Colorectal Cancer

• Etiology and risk factors:
  • Diet rich in animal fat and low in vegetable fiber
  • Alcohol and salt consumption
  • Genetic risk
  • Age (≥40 years)
  • Adenomatous colic polyps (≥2 cm, villous, dysplasia)
  • Chronic inflammation (e.g., ulcerative colitis, Crohn's disease)
• Extension and dissemination:
  • Direct extension (transparietal, peritoneum, neighboring organs)
  • Lymphatic dissemination (regional, juxtaregional lymph nodes)
  • Hematogenous dissemination (liver, lung, bone)

ENT Cancers

• Risk factors:
  • Smoking
  • Alcohol consumption
  • Food factors
  • Viral infections (e.g., Epstein-Barr virus)
  • Local hygiene
  • Professional factors (e.g., nickel, wood dust)
• Molecular biology:
  • Receptor for epidermal growth factor (EGFR 1)
  • Protein p53
  • E-cadherin

Esophageal Cancer

• Extension and dissemination:
  • Continuity (trachea, lung, mediastinum, pleura, aorta, heart, diaphragm)
  • Lymphatic extension (mediastinal, supraclavicular, cervical lymph nodes)
  • Hematogenous dissemination (liver, lung, bone)
• Diagnostic factors:
  • Clinical symptoms (dysphagia, weight loss, sore throat, retrospective pain, Horner syndrome)
  • Paracclinical examinations (esophagoscopy, barium passage, CT-scan, MRI, bronchoscopy, biopsy)

Gastric Cancer

• Etiology:
  • Consumption of salted and smoked foods
  • Nitrosamines
  • Gastric ulcer
  • Biermer anemia
  • Helicobacter pylori infection
  • Gastrointestinal polyps
  • Stomach operations
  • Poor nutrition
• Prognostic factors:
  • Precursor lesions (intestinal metaplasia, gastric mushroom, hyperplastic gastric fields)
  • Clinical symptoms (vagal discomfort, duration, weight loss, anorexia, dysphagia, vomiting)### Epidemiology
• Studies the distribution and determinants of health events in a population and applies the results to control the state of health
• Purpose:
  • To study the frequency, distribution, and determinants of cancer
  • To quantify the risk associated with exposure to etiologic factors
  • To evaluate the efficiency of preventive measures
• 2 types of epidemiologic studies: descriptive and analytical

Viral Agents

• RNA viruses (retroviruses):
  • Human T cell leukemia virus Type 1: T cell leukemia in adults
  • Human T cell leukemia virus Type 2: hairy cell leukemia
  • HIV: non-Hodgkin lymphoma, Kaposi sarcoma, Hodgkin lymphoma, cervical carcinoma
  • Hepatitis C virus: hepatocarcinoma
• DNA viruses (oncodnaviruses):
  • Hepatitis B virus: hepatocarcinoma
  • Human papillomavirus (HPV): tumors in the anogenital area
    • HPV 16 and 18: cervical cancer
  • Epstein-Barr virus: Burkitt lymphoma and nasopharyngeal cancer

Behavioral Factors

• Tobacco smoking:
  • Causes bronchopulmonary neoplasms, ear-nose-throat cancers, esophageal, kidney, bladder, pancreas, and cervical and liver cancers
  • Passive tobacco smoking is also carcinogenic
  • Smoking is carcinogenic due to nicotine, carbon oxide, nitrosamines, and polycyclic aromatic hydrocarbons
• Alcohol:
  • Causes esophageal, oral cavity, oro-hypopharynx, and liver carcinomas
• Diet:
  • Causes digestive cancers, breast, bladder, prostate, and endometrial cancer
  • Food carcinogens: tea, coffee, cocoa
  • Salted, dried, smoked foods rich in nitrates and nitrites cause gastric and esophageal cancer
  • Increased consumption of fat and proteins causes colorectal, breast, and endometrial cancer
  • Diet rich in fibers, vitamins, and antioxidants has a protective role
• Sexual activity:
  • Breast cancer: early menarche, nulliparity, first pregnancy over 25-30 years old
  • Endometrial cancer: nulliparity, oral contraceptives, long-term estrogen substitution, and tamoxifen
  • Ovarian cancer: decreases with the use of oral contraceptives and lactation

Characteristics of a Tumor Cell

• Infinite division induced by a lack of response to host's control signals
• Loss of "social" relation with neighboring cells, followed by progressive invasion of the adjacent tissues
• Capacity of migration at distance in order to create new cell colonies or metastases
• Genetic heterogeneity
• Clonal proliferation is a specific characteristic of cancer

Premalignant States

• Precancerous conditions: molecular, histological, or clinical alterations that bear a higher risk of transforming into cancer
• Examples: rectocolic polyposis syndromes, xeroderma pigmentosum, neurofibromatosis type I (Von Recklinghausen syndrome)
• Precancerous lesions: defined histologically as non-invasive lesions with a predictable likelihood of becoming malignant
• Include: atypical hyperplasia, metaplasia, dysplasia

Pretherapeutic Evaluation

• Evaluation of loco-regional and distant extension:
  • Local extension: specify tumor size and rapport with healthy structures
  • Lymphatic extension: lymph nodes amenable to palpation or imaging studies
• Hematogenic extension:
  • Lung metastases: any localization, plain radiographs or CT
  • Liver metastases: digestive tumors, breast, lung cancer, melanoma, and ultrasonography, CT, MRI, with contrast, or scintigraphy
  • Bone metastases: breast, prostate, lung, thyroid, and renal cancer, and scintigraphy
  • Central nervous system metastases: lung, testicular, breast, renal cancer, and melanoma

Evaluation of the Aggressiveness of the Tumor

• Methods:
  • Anamnestically: history of the lesion and its growth speed
  • Clinically: local inflammatory signs
  • Imaging studies: speed of growth of the lesion
  • Blood tests for tumor markers
  • Evaluating histological type, grading, and mitotic activity

Paraneoplastic Syndromes

• Indirect signs and symptoms that can precede or appear with the clinical tumor and disappear with cancer therapy
• Can reappear along with a relapse
• Pathogenesis:
  • Production of a protein that has a role in normal physiology
  • Production of a protein that inhibits compounds in normal physiology
  • Immune reaction by the host towards the tumor and autoimmune reactions

Curative Surgery

• Primordial role in the treatment of solid tumors
• Includes the removal of the primary tumor and lymphadenectomy
• 3 types of resection:
  • R0: microscopically negative resection margin(s)
  • R1: macroscopically negative but microscopically positive resection margin(s)
  • R2: macroscopically positive resection margin(s)
• Close margin: distance between tumor cells and resection margin (1-5 mm)