questions 4

Bladder Cancer / Transitional Cell Carcinoma

Topic updated on 05/19/17 7:37am

Introduction
  • Most common cancer of the bladder
    • most commonly in lateral or posterior walls of bladder base
    • can also occur in renal calyces, renal pelvis, and ureters
    • usually a multifocal disease with papillary histology
  • Risk factors
    • phenacetin
    • smoking 
    • aniline dyes
    • cyclophosphamide
    • beer consumption (nitrosamines)
    • Schistosoma hematobium
      • more commonly produce squamous cell carcinoma but can also produce TCC
Presentation
  • Symptoms
    • hematuria/dysuria 
Differential
  • Urethral cancer
    • if blood is present with urethral discharge think urethral cancer 
Evaluation

  • Intravenous pyelography (IVP) and cystoscopy 
  • Alternative modalities include ultrasonography and CT scan
  • CT urography is a relatively new technique producing images similar to IVP while also giving traditional CT images.
Prognosis
  • Improved prognosis with blood group antigen expression of the tumor


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Qbank (3 Questions)

TAG
(M2.ON.45) A 57-year-old man presents to general medical clinic with hematuria. He first noticed the color of his urine darkening several weeks ago, and it has recently worsened. He denies any pain. Vital signs are stable. Physical examination is within normal limits. He has no costovertebral angle tenderness. Urinalysis is positive for heme and urine culture is negative. Urine cytology reveals malignant cells. An image from subsequent cystoscopy is shown in figure A. Biopsy confirms this is the most common tumor of the genitourinary tract. All of the following are risk factors for this tumor EXCEPT? Topic Review Topic
FIGURES: A          

1. Cyclophosphamide
2. Smoking
3. Aniline Dyes
4. HIV
5. Phenacetin

PREFERRED RESPONSE ▶
TAG
(M2.ON.57) A 67-year-old male presents to his primary care physician for his annual physical examination. He has no significant past medical history and is generally healthy. At the conclusion of the visit, he mentions, embarrassingly, that he has noted some bloody discharge from his penis and is concerned. Which of the following is the most likely diagnosis? Topic Review Topic

1. Renal cell carcinoma
2. Ureteral carcinoma
3. Transitional cell carcinoma of the bladder
4. Prostate cancer
5. Urethral cancer

PREFERRED RESPONSE ▶
TAG
(M2.ON.62) A 72-year-old man presents to his primary care physician complaining of blood in his urine. He states that there is blood present throughout the void, but that he does not experience any pain or burning on urination. He smoked 1 pack per day for 50 years, but quit 6 years ago. Vital signs are within normal limits. Urinalysis is significant for 10 RBC/hpf, but no white cells and no casts. Urine culture is negative, and basic chemistries are within normal limits. Of the following, which is the best next step in management? Topic Review Topic

1. Kidney, ureter, bladder plain film series
2. Cystoscopy and intravenous pyelography
3. MRI abdomen and pelvis
4. Urine cytology
5. Antibiotics

PREFERRED RESPONSE ▶
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