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Three Oncologists
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Transitional Cell Carcinoma
Of BladderBy
Dr Haris Hamid
Post Graduate Resident
Institute of Kidney Diseases, Peshawar
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Overview Transitional cell carcinoma currently named as Urothelial
Carcinoma is a common urological cancer
Bladder cancer is often described as a polyclonal field change
defect with frequent recurrences due to a heightened potential
for malignant transformation
The clinical course of bladder cancer carries a broad spectrum
of aggressiveness and risk
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Epidemiology TCC bladder is the 4th most
common cancer in men and 10th
most common cancer in women
33 % increase in development of
TCC has been reported in annual
cancer registry from 1985-2000
Smoking is 50 % responsible indevelopment of TCC
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Clinical Features Painless Haematuria in 80-
90%
20-30 % Presents as
irritative LUTS
Rare presentation includes
Bone pains
Lower limb Oedema
Flank pain
Incidental diagnosis during
cystoscopy for Prostate
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Diagnostic Work up: Laboratory Urine R/E, Culture and
Voided Urine cytology
Newer molecular andgenetic markers
BTA
Nuclear Matrix Proteins
NMP-22 Multitarget interphase
fluorescence in situ hybridization
(FISH) assay
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Diagnostic Work up: Radiology USG Abdomen/Pelvis
IVU before cystoscopy and
then yearly in surveillance
Contrast CT scan
Abdomen/Pelvis
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A newly Diagnosed TCC: Staging70%
25%
5%
Superficial disease Muscle Invasive Metastatic
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Three year audit of clinical presentation, diagnosis and
management of Bladder tumour: Experience at Institute of
Kidney Diseases Peshawar
Liaqat Ali, Haris Hamid, Muhammad Shahzad & Nasir Orakzai
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To present three year audit of clinical presentation, diagnosisand management of Bladder tumour: Experience at Institute of
Kidney Diseases Peshawar
Objectives
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Methods
Study Design: Descriptive Study
Setting: Institute of Kidney Diseases Peshawar
Durations: Jan 2009 till December 2011
Sample Size: 282 patients
Inclusion criteria: Newly diagnosed cases of TCC on history,
labs and cystoscopy
Data Collection Proforma and analyzed on SPSS
Procedure & Analysis:
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Management plan
All the study group underwent transurethral
resection of the bladder growth.
Specimens were sent for histopathology. Check cystoscopies were performed 3monthly
for 1 year, 6 monthly for 2 years and then
yearly for 3 years.
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Intravesical mitomycin Post operative intravesical mitomycin was
given to all the patients with superficial
disease and Multiple growths
Large primary tumour
Recurrent tumours
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Results
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Top ten disease chart n=22832
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Age and Gender
Median age: 47 years ( 16-77 years)
Gender: Male 158 patients (56%)
Female 124 patients ( 44%)
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Clinical Features
0
50
100
150
200
250
300
Painlesshaematuria
LUTS Incidentaldiagnosis
252
255
(90%)
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Risk Factor: tobacco use n=139 (46.8%)
Cigarette, 70
Snuff, 60
Hukka, 9
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Cystoscopic Findings of Bladder Tumourn=282
Papillary, 203
Solid, 40
Mixed, 39
(71.7%)
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Grade of TCC n=297
183
99
Low grade (1,2) High Grade (3)
(65%)
(35%)
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Superficial &Muscle Invasive TCC!!! Comparative
literature (%)
75
25
40
60 58
42
International Rafique Present study
Superficial TCC
Muscle Invasive
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Recurrences in superficial TCCn=170
Multiple Recc, 48
No recurrence, 123
(29 %)
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CRP as predictor for Muscle Invasion n=188
No of patients
Superficial
disease TCC
No of Patients
Muscle Invasive
Mean CRP
Superficial
Mean CRP
Muscle Invasive
103 85 9.2 9.8
p=0.154
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CONCLUSION
The hall mark of presentation is painless haematuria.
Although superficial bladder tumour was still the most
prevalent stage of tumour in our study but the
occurrence of muscle invasive disease is quite high in
this region i.e 42-60 % as compared to European andU.S literature.
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Recommendation
We recommend
another study to find
the Risk Factors
associated with this
aggressive behaviour
of TCC bladder in this
region.
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