• More common in whites, higher socio-economic status and in | Surgery videos & books

• More common in whites, higher socio-economic status and in malesQ, in 6th and 7th decade
• 75% are localized to bladder and 25% have spread to regional nodes or distant sites at the time of presentation
• Most tumors develop at trigone and adjacent posterolateral wallQ with ureteral involvement
• Tumors tend to be multifocalQ in bladder
Pathology
• MC type grossly is papillary and histologically, TCC.Q
Precursor lesions of invasive urothelial cancer
• Non-invasive papillary tumor (Kiss ulcer)
Q causes painless, profuse paroxysmal hematuria
• Carcinoma in situ (Malignant cystitis)Q
Carcinoma in situ (Malignant cystitis)
• Typically presents as irritativeQ lower urinary symptoms
• Common in high gradeQ tumors
• Urinary cytology is IOCQ
• Urine cytology is positive in 80–90% cases because of poor cohesiveness of cells
• Associated with increased chances of recurrence and poor prognosis
• Treatment: two cycles of BCGQ, radical cystectomy in cases recurrence
Clinical Features
• MC symptom: Painless hematureaQ (85% cases)
• Hematuria is gross or microscopic, intermittentQ rather than constant
• Vesical irritabilityQ: frequency, urgency and dysurea
• Bone pain and abdominal pain in advanced disease
• MC site of lymphatic metastases: Pelvic lymph nodes (obturator is MC)Q
• MC site of hematogenous spread: liverQ > lung
Diagnosis
Cystoscopy
• Diagnosis and initial staging is made by cystoscopy and transurethral resection (TUR) Q
• Urinary Cytology
• Cytologic examination of exfoliated cells are useful in detecting cancer in symptomatic patients and assessing response to
treatmentQ
• Most useful for early diagnosis of recurrence in TCCQ