Bladder Cancer Overview

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Questions and Answers

What imaging techniques are recommended for evaluating deeply lying lymph nodes?

CT, MRI, PET/CT, MRI with paramagnetic iron contrast

Which types of cancer are associated with metastases to the liver?

Testicular cancer (correct)

Lung cancer (correct)

Digestive tumours (correct)

Melanoma (correct)

Breast cancer (correct)

Paraneoplastic syndromes can disappear with cancer therapy.

True

Curative surgery involves the removal of the primary tumour + ____________.

lymphadenectomy Signup and view all the answers

Match the proteins with their roles in the pathogenesis of paraneoplastic syndromes:

ACTH = Production of a protein which has a role in normal physiology PTH = Production of a protein which has a role in normal physiology Interleukin 1, TNFα = Production of a protein which inhibits compounds in normal physiology Systemic lupus erythematosus, dermatomyositis, Eaton-Lambert myasthenic syndrome = Immune reaction by the host toward the tumor and autoimmune reactions Signup and view all the answers

What are the risk factors associated with bladder cancer?

Infection with schistosoma haemotobium Signup and view all the answers

Bladder cancer is commonly associated with abnormal metabolism of tryptophan.

True Signup and view all the answers

What is the primary risk factor for breast cancer in terms of genetics?

mutation of the BRCA-1 gene Signup and view all the answers

Which gene mutation increases the risk of breast cancer by 85%?

BRCA-1 Signup and view all the answers

Match the following cancer types with their histological type:

Bladder Cancer = 90% transitional carcinomas Breast Cancer = Mutations in the BRCA genes Lung Cancer = 40-50% Squamous Cell Carcinoma Signup and view all the answers

What are some risk factors associated with hematogenic dissemination in advanced cancer stages?

First delivery at greater than or equal to 28 years Signup and view all the answers

What is the correlation between the degree of malignancy and survival at 5 years in cancer patients?

The degree of malignancy is correlated with survival at 5 years, with higher malignancy grades associated with lower survival rates. Signup and view all the answers

What is the primary purpose of primary prevention in cancer prophylaxis? It aims to avoid the development of cancer by controlling the action of _ __.

risk factors Signup and view all the answers

Match the following hormone therapy types with their correct usage:

Hormone suppression therapy (ablative) = Ovarian castration: Breast cancer Additive hormone therapy - anti-estrogenic = Tamoxifen, toremifen, raloxifene, fulvestrant: Breast cancer Additive hormone therapy - antiandrogens = Flutamide, bicalutamide, nilutamida, ciproteron acetate: Prostate cancer Signup and view all the answers

Radiation therapy is a major oncological treatment that benefits 100% of all cancer patients.

False Signup and view all the answers

Study Notes

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)

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Description

This quiz covers the basics of bladder cancer, including its incidence, risk factors, and pathological anatomy. Topics include the ratio of male to female cases, industrial and environmental risk factors, and the role of smoking and certain medications.