膀胱癌

Bladder cancer (papillary CA)

　

56, M, heavy smoker, Thai immigrant c/o painless hematuria x days. Once loved to swim in a lake harbor many snails (risk of schistosomiasis). Lung-clear, abd nontender; no palpable mass; genitalia WNL; No LAD. 

CBC: slight normocytic normochromic anemia.

UA: hematuria & abundant epith cells. Remainder routine bld w/u & stool –N∘.

IVP/Cystogram : irregular filling defects above trigone.

Cytology of urine: malig cells.

Bladder Bx : (nodular, cauliflower-like w/ central necrosis) grade I, stage B transitional cell CA (TCC) arising fr uroepith & projecting into bladder.

　

-Man (4x), expose to arylamines, smoke, Schistosoma haematobium, analgesic abuse (esp. phenacetin), cyclophosphamide.

-transitional cell ca: a/w mutation in p53 (tumor suppressor gene) & deletion in Chrom 9q.

Cx : invasion of perivesicular tiss, ureteral invasion w/ urinary obst (àhydronephrosis, APN, RF), Mets (lung, bone, liver)

　

Tx:

Surgery (aggressive fulguration電灼)

R/T ; C/T