Lower Urinary Tract Carcinoma PDF

# LOWER URINARY TRACT CARCINOMA ## Urothelial (Transitional Cell) Carcinoma A. Malignant tumor arising from the urothelial lining of the renal pelvis, ureter, bladder, or urethra 1. Most common type of lower urinary tract cancer; usually arises in the bladder B. Major risk factor is cigarette sm...

# LOWER URINARY TRACT CARCINOMA ## Urothelial (Transitional Cell) Carcinoma A. Malignant tumor arising from the urothelial lining of the renal pelvis, ureter, bladder, or urethra 1. Most common type of lower urinary tract cancer; usually arises in the bladder B. Major risk factor is cigarette smoke; additional risk factors are naphthylamine, azo dyes, and long-term cyclophosphamide or phenacetin use. C. Generally seen in older adults; classically presents with painless hematuria D. Arises via two distinct pathways (Fig. 12.21) 1. Flat - develops as a high-grade flat tumor and then invades; associated with early p53 mutations 2. Papillary - develops as a low-grade papillary tumor that progresses to a high-grade papillary tumor and then invades; not associated with early p53 mutations E. Tumors are often multifocal and recur ("field defect"). ## Squamous Cell Carcinoma A. Malignant proliferation of squamous cells, usually involving the bladder B. Arises in a background of squamous metaplasia (normal bladder surface is not lined by squamous epithelium) C. Risk factors include chronic cystitis (older woman), Schistosoma hematobium infection (Egyptian male), and long-standing nephrolithiasis. ## Adenocarcinoma A. Malignant proliferation of glands, usually involving bladder B. Arises from a urachal remnant (tumor develops at the dome of the bladder), cystitis glandularis, or exstrophy (congenital failure to form the caudal portion of the anterior abdominal and bladder walls)