Radiology and Physical Medicine

High-grade papillary bladder cancer CANCER PAPILAR DE VEJIGA DE ALTO GRADO

July 21, 2014 | Translate

Reason for visiting

71 years old man diagnosed with high-grade papillary bladder cancer touching lamina propria (cT1b N0 M0). This was found in a pathological study of TUR due 2 month hematuria. He was referred to our clinic for adjuvant oncological treatment

diagnostic algorithm

Personal history

Ex-smoker

High blood pressure

No known drug allergies

No interesting family background

Complementary tests

We have to do a full study when we suspect urinary tract cancer:

Urinary sediment searching for hematuria. Hematuria: rule out a possible urinary tract neoplasia

Ultrasonography sensitivity for catching bladder tumors is 95% , specially with a full bladder. If that was not enough, we can make urethrocystoscopy

Abdominal and pelvis CT with or without contrast agent and multiphase protocol at baseline, portal phase and excretory phase (Uro-CT). Uro-CT has replaced IVU in the diagnosis of hematuria

Extension study

Thoracoabdominopelvic CT, thoracoabdominopelvic MR and always bone scintigraphy (bone metastasis are frequent)

A histopathological study after RTU was positive for high-grade papillary bladder cancer touching lamina propria (cT1b N0 M0)

Serum-proteomics probing appears to be an encouraging and least-invasive tactic for screening and grading of bladder cancer

Treatment

Treatment of choice: TUR

Non-invasive high-grade papillary tumors (cT1b N0 M0) are very likely to return after treatment. We recommend:

Inmediate instillation of BCG (Bacillus Calmate-Guerin) intravesical after surgery. Maintenance: at least 1 year

Intravesical chemotherapy with mitomycin C (or electromotive mitomycin therapy, possibly better ) or doxorubicin hydrochloride

Both of them begin several weeks after surgery and are administered 1 / week, 6 weeks

Radiation therapy may be employed: some minutes / 5 days / week, for several weeks

Bibliography

Franco Á, Tomás M, Alonso-Burgos A. Intravenous urography is died. Long live the computerized tomography! Actas Urol Esp (Madrid). 2010 oct; 34 (9). Available on: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0210-48062010000900004

Bansal N, Gupta A, Sankhwar SN, Mahdi AA. Low- and High-grade bladder cancer appraisal via Serum-Based Proteomics Approach. Clin Chim Acta. Elsevier B.V.; 2014 may 26. Avaliable on: https://www.ncbi.nlm.nih.gov/pubmed/24875752

Nakada T, Akiya T, Yoshikawa M, Koike H, Kayayama T. Intravesical instillation of doxorubicin hydrochloride and its incorporation into bladder tumors. Available on: https://www.ncbi.nlm.nih.gov/pubmed/4009823

Personal notes about subject of “Urology”, 4th Degree in Medicine

 

Author: Fátima Ramón Vigo
4º Course, Medicine. Granada University

Motivo de consulta

Hombre de 71 años diagnosticado de cáncer papilar de vejiga de alto grado que contacta con lámina propia (cT1b N0 M0) tras RTU por hematuria de 2 meses. Solicita tratamiento adyuvante

algoritmo diagnóstico

Antecedentes personales

Ex-fumador

HTA

NAMC

Antecedentes familiares sin interés

Pruebas complementarias

Ante sospecha de cáncer de vía urinaria, hacer estudio completo:

Sedimento urinario: ¿hematuria? Ante hematuria, siempre descartar una posible neoplasia de vías urinarias

La sensibilidad de la ecografía para detectar tumores en la vejiga es del 95% , sobre todo con vejiga llena. Si quedase duda: uretrocistoscopia

TAC abdominopélvico sin y con contraste en protocolo multifásico (situación basal, fase portal y fase excretora (Uro-TC). La Uro-TC ha sustituido a la UIV en diagnóstico de hematuria

Estudio de extensión

TAC toraco-abdomino-pélvico, RNM toraco-abdomino-pélvico. SIEMPRE gammagrafía ósea (metástasis óseas frecuentes)

Estudio anatomopatológico tras RTU curativa positivo para cáncer papilar de vejiga de alto grado que contacta con lámina propia (cT1b N0 M0)

El sondeo de proteínas en suero podría ser una táctica alentadora y menos invasiva para detección y clasificación de cáncer de vejiga 

Tratamiento

Curativo de elección: RTU

Tumores papilares no invasivos de alto grado (cT1b N0 M0) tienen gran probabilidad de regresar tras tratamiento. Recomendamos:

Instilación inmediata de BCG (Bacillus Calmette-Guerin) intravesical tras cirugía. Mantenimiento de al menos 1 año

Quimioterapia endovesical con mitomicina C (o terapia electromotriz con mitomicina, posiblemente mejor ) o hidrocloruro de doxorrubicina

Ambos se comienzan varias semanas después de la cirugía y se administra 1 / semana, 6 semanas

Se puede emplear radioterapia: 3 minutos / 5 días / semana, varias semanas

Bibliografía

Franco Á, Tomás M, Alonso-Burgos A. La urografía intravenosa ha muerto, ¡viva la tomografía computarizada! Actas Urol Esp (Madrid). 2010 oct; 34 (9). Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0210-48062010000900004

Bansal N, Gupta A, Sankhwar SN, Mahdi AA. Low- and High-grade bladder cancer appraisal via Serum-Based Proteomics Approach. Clin Chim Acta. Elsevier B.V.; 2014 may 26. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24875752

Nakada T, Akiya T, Yoshikawa M, Koike H, Kayayama T. Intravesical instillation of doxorubicin hydrochloride and its incorporation into bladder tumors. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/4009823

Apuntes personales de la asignatura “Urología” de 4º de Grado en Medicina.

 

 

Autora: Fátima Ramón Vigo
4º Curso, Grado de Medicina. Universidad de Granada

Categorised in: Clinical Cases