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    4th 11th: Age 60-70yrs

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    rohit
    This document discusses bladder cancer. It is the 5th most commonly diagnosed cancer and the 11th most common cancer in women. In 2017, 79,030 cases were diagnosed in the US and 16,870 people died from the disease. Recurrence rates range from 50-80%. Risk factors include smoking, occupational exposures, and medical history. Signs include blood in the urine and pain. Diagnosis involves cystoscopy and biopsy. Treatments include surgery to remove all or part of the bladder as well as chemotherapy and new immunotherapies.

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    4th 11th: Age 60-70yrs

    Uploaded by

    rohit
    28 views33 pages
    This document discusses bladder cancer. It is the 5th most commonly diagnosed cancer and the 11th most common cancer in women. In 2017, 79,030 cases were diagnosed in the US and 16,870 people died from the disease. Recurrence rates range from 50-80%. Risk factors include smoking, occupational exposures, and medical history. Signs include blood in the urine and pain. Diagnosis involves cystoscopy and biopsy. Treatments include surgery to remove all or part of the bladder as well as chemotherapy and new immunotherapies.

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    Original Title

    Bladder cancer

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    This document discusses bladder cancer. It is the 5th most commonly diagnosed cancer and the 11th most common cancer in women. In 2017, 79,030 cases were diagnosed in the US and 16,870 people died from the disease. Recurrence rates range from 50-80%. Risk factors include smoking, occupational exposures, and medical history. Signs include blood in the urine and pain. Diagnosis involves cystoscopy and biopsy. Treatments include surgery to remove all or part of the bladder as well as chemotherapy and new immunotherapies.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    28 views33 pages

    4th 11th: Age 60-70yrs

    Uploaded by

    rohit
    This document discusses bladder cancer. It is the 5th most commonly diagnosed cancer and the 11th most common cancer in women. In 2017, 79,030 cases were diagnosed in the US and 16,870 people died from the disease. Recurrence rates range from 50-80%. Risk factors include smoking, occupational exposures, and medical history. Signs include blood in the urine and pain. Diagnosis involves cystoscopy and biopsy. Treatments include surgery to remove all or part of the bladder as well as chemotherapy and new immunotherapies.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 33

    79,030 600K + living most

    diagnosed in with bladder 5th common


    2017 cancer cancer

    16,870 will Most


    Expensive CA Age 60-
    die in 2017
    to teat 70yrs

    50% - 80% 4th 11th


    most most
    recurrence common common in
    rate in men women

    1
    Signs Symptoms

    Hematuria Abdominal pain

    Dysuria Fatigue

    Urgent need to Lower back pain


    urinate
    Appetite or weight
    Urinary retention loss

    2
    3x more common in smokers

    Chemical/occupational exposure

    Arsenic in water

    Race, age, gender, birth defects

    Chronic bladder inflammation

    Medical history recurrence

    Low fluid intake

    Previous cancer treatment


    4
    5
    • Dry cleaners
    • – Painters
    • – Autoworkers
    • – Truck drivers
    • – Paper manufacturers
    • – Metal workers
    • – Plumbers
    • – Hairdressers
    • – Tire and rubber workers
    • – Chemical workers
    • – Petroleum workers
    7
    • Gross hematuria most common
    Most commonly intermittent
    Gross 68-97%
    Microhematuria 11%
    • Timing of hematuria

    • Initial – suggests urethral source

    • Terminal – suggests posterior urethra, bladder neck,


    prostate
    • Continuous – suggests bladder etiology • Irritative voiding
    symptoms (especially in absence of UTI
    Diagnostics

    • Cystoscopy

    • Tissue sample

    • Radiologic Tests

    • CT scan

    • Stage & Grade

    9
    10
    Treatments

    • TURBT

    • Intravesical therapy

    • Bladder removal and


    urinary reconstruction

    • Chemotherapy
    Immunotherapy is the first
    significant FDA approved • Bladder preservation
    advancement in bladder cancer
    treatment in over 30 years. • Immunotherapy
    11
    • Penile cancer is a relatively rare SCC. It usually originates
    in the epithelium of the inner prepuce and glans. It shares
    similar pathology and natural history with SCC of the
    oropharynx, female genitalia (cervix, vagina and vulva),
    and anus. Phimosis, poor hygiene, and smoking are the
    major risk factors for penile cancer.
    13
    Uncommon malignancy in developed countries

    Higher incidence rates are seen in Africa and Asia (10% to


    20%)

    Commonly affects those between 50 and 70 years of age

    22% of patients are less than 40 years of age


    • Intact foreskin

    • Phimosis (25%)

    • Precancerous lesions are found in 15%-20% of patients

    • Human papilloma virus(HPV 16,18)

    • Chronic inflammatory conditions (eg, balanoposthitis and


    lichen sclerosus et atrophicus)
    • Primary malignancies (those that originate from either the
    soft tissues, urethral mucosa, or covering epithelium)

    • Secondary malignancies (ie, those that represent metastatic


    disease and often affect the corpus cavernosum
    • squamous cell carcinoma is found on
    glans: 48%,prepuce: 21%,glans & prepuce:9%,coronal
    sulcus: 6%, and shaft: <2%

    • Primary, non squamous malignancies comprise <5% of


    penile cancers.
    • Sarcomas are the most frequent non squamous penile
    cancers, followed by melanomas, basal cell carcinomas, and
    lymphomas
    • Area of induration or erythema to a non healing ulcer or a
    warty exophytic growth

    • Palpable inguinal lymphadenopathy is present at diagnosis in


    58% of patients ( 20%-96%)

    • In non palpable inguinal lymph nodes at the time of resection


    of the primary tumor, 20% will found to have metastatic
    disease
    Jackson
    • Grade

    • Depth of invasion

    • Number of positive lymph nodes

    • Unilateral or bilateral inguinal extension

    • Pelvic nodes involvement

    • Presence of lymph node extracapsular extension


    • Physical examination

    • Cytological and/or histological diagnosis

    • Chest x-ray

    • CT scan/PET-CT scan

    • Bone scan
    • Small tumors limited to foreskin:
    • circumcision+2-cm margin

    Circumcision alone, especially with tumors in the proximal


    foreskin, may be associated with recurrence rates of 32%

    • Small superficial penile cancers:


    • Moh’s micrographic surgery
    • Radiation therapy (EBRT/brachytherapy)
    • RT has yielded local control rates similar to surgical resection:
    • Carcinomas involving the glans & distal shaft:
    • partial penectomy excising 1.5 to 2 cm of normal
    tissue proximal to the margin of the tumor.

    This should leave a 2.5- to 3-cm stump of penis


    • Bulky T3 or T4 proximal tumors involving the base of the
    penis:
    total penectomy with perineal urethrostomy
    Lymphadenectomy in Penile Cancer

    • Lymphadenectomy is indicated in patients with palpable


    inguinal lymphadenopathy that persists after treatment of
    the primary penile lesion following a course of antibiotic
    therapy
    • Staging tool
    • Identifies patients likely to benefit from adjuvant chemo
    • Adds to locoregional control
    • No additional morbidity
    • If pre-op pelvic node identified : NACT followed by surgery in
    responders

    Value of pelvic LND unproven


    Patients with minimal inguinal disease & limited
    pelvic LN mets may benefit
    • >2 metastatic inguinal nodes

    • Extranodal extension of disease

    • Pelvic lymph node metastases


    • Neoadjuvant chemo + surgery in
    responders

    • Palliative chemotherapy

    • Chemotherapy + radiation therapy


    • Persistent lymphorrhoea
    • Wound breakdown, necrosis, infection
    • Lymphocyst
    • Femoral blowout
    • Lymphangitis
    • Lymphoedema of lower extremity
    • Uncommon disease
    • No systematic study & complete absence of RCTs
    • Small no of patients over a long time

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