Urothelial cancer (UC) is the most common type of bladder cancer. It occurs from urothelium lining the bladder, ureters, renal pelvis, and parts of urethra.
Bladder cancer is a common urologic cancer that originates in the urothelium mucosal layer of the bladder.
About 90% of bladder cancers are urothelial carcinoma along with 7% of kidney cancers including renal pelvis.
Bladder is a triangle-shaped organ between hipbones, above urethra and below kidneys.
Urothelium is made of cells to stretch bladder when it fills with pee and collapses when it is empty.
Abnormal urothelial cells in bladder cancer spread from inner lining to bladder layers and may spread through bladder wall.
Kidneys filter blood to create urine stored in renal pelvis at middle of each kidney.
Types of Urothelial Cancer:
Non-invasive
Invasive
High-grade vs. Low-grade
Epidemiology
Urothelial cancer ranks 10th globally with 573000 new cases and 212000 deaths in 2020. U.S. experiences high incidence with 82290 new cases every year.
Urothelial cancer is more prevalent in older men than women usually individuals with >65 years old.
Bladder cancer rates are double in White men compared to Black men. Smoking contributes to nearly half of all bladder cancer cases and increase the risk three times compared to non-smokers.
Anatomy
Pathophysiology
Their development is influenced by environmental risks, genetic mutations, and molecular changes in urinary tract cell growth.
Mutations in FGFR3 and HRAS are common in low-grade bladder cancer to promote abnormal cell growth and division in non-invasive tumors.
The main molecular pathway for UCs is the development of a papillary tumor in the bladder. If untreated, it can penetrate the basement membrane and spread further.
High-grade cancers progress, while low-grade cancers have unique molecular pathways and rarely progress.
Superficial bladder tumors in urothelium or lamina propria have good prognosis, with high recurrence risk but low progression to muscle-invasive cancer.
Muscle invasion in cancer predicts poor outcomes with higher chances of metastasis and cancer-related death.
High-grade tumors are more aggressive with increased risk of invasion and spreading.
They have higher chances of recurrence, progression, and mortality.
Clinical History
Collect details including presenting symptoms, family and medical history to understand clinical history of patient.
Acute renal failure, Severe pain from metastasis, Respiratory distress from lung metastases, Sepsis from UTI.
Differential Diagnoses
Urinary Tract Infection
Nephrolithiasis
Renal Cell Carcinoma
Hemorrhagic Cystitis
Ureteral Trauma
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
BCG instillation is effective for treatment of high-risk bladder carcinoma. It is the best intravesical therapy for CIS and T1 tumors.
BCG vaccine or chemotherapy instilled post-endoscopic resection of papillary tumors within 2 to 4 weeks
Gene therapy Nadofaragene firadenovec delivers IFNα2b gene using non-replicating adenoviral vector to bladder urothelium.
Urethrectomy for bladder cancer in men is uncommon as most achieve negative urethral margins. Delayed urethrectomy may be an option for those with positive margins.
Men with stage T2-T4 disease should undergo radical cystoprostatectomy, while women should have anterior pelvic exenteration and lymphadenectomy.
Salvage cystectomy has comparable morbidity/mortality rates to first-line radical cystectomy but limited reconstructive options due to irradiated bowel.
There are various surgical options available including, Transurethral Resection of Bladder Tumor (TURBT), Radical Cystectomy, Nephroureterectomy, and Intravesical Therapy.
use-of-phases-in-managing-urothelial-cancer
In the initial diagnosis phase, evaluation of medical history, physical examination and imaging studies to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of Antineoplastics, FGFR Inhibitors, Anti-Nectin antibody, Gene Therapy, and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with urologist are schedule to check the improvement of patients along with treatment response.
the duration of the therapy continues until disease progression, or unacceptable toxicity occurs
Renal Cell Carcinoma:
800 mg given IV over 1hr every 2-weeks in combination with axitinib 5 mg given orally 2 x day
the duration of the therapy continues until disease progression, or unacceptable toxicity occurs
Dose Adjustments
Renal Dose Adjustments:
Serum creatinine >1.5 and up to 6 x ULN: withhold therapy and take prednisone or equivalent at 1-2 mg per kg per day and followed by a corticosteroid taper
Resume therapy in patients with complete or partial resolution (Grade 0-1) of colitis or diarrhea after corticosteroid taper
Serum creatinine > 6 x ULN: permanently discontinue therapy.
Liver Dose Adjustments:
AST/ALT >3 and up to 5 x ULN or total bilirubin > 1.5 and up to 3 x ULN:
then withhold therapy and give prednisone or equivalent at 1 to 2 mg per kg per day, followed by a corticosteroid taper
resume therapy in patients with complete or partial resolution Grade 0 -1 of hepatitis after corticosteroid taper
AST/ALT >5 x ULN or total bilirubin > 3 X ULN then Permanently discontinue therapy.
or 1200 mg given IV every three weeks, or 1680 mg given IV every four weeks
Continue the course until disease progression, or unacceptable toxicity occurs
Using a ureteral catheter or nephrostomy tube, administer 4 mg/mL with a total instillation volume of 15 mL (60 mg of mitomycin) or less.
Administer every week for six weeks
Patient receives a full response 3 months following the first 6 weeks: For 11 further instillations, the administration may continue once every month.
Urothelial cancer (UC) is the most common type of bladder cancer. It occurs from urothelium lining the bladder, ureters, renal pelvis, and parts of urethra.
Bladder cancer is a common urologic cancer that originates in the urothelium mucosal layer of the bladder.
About 90% of bladder cancers are urothelial carcinoma along with 7% of kidney cancers including renal pelvis.
Bladder is a triangle-shaped organ between hipbones, above urethra and below kidneys.
Urothelium is made of cells to stretch bladder when it fills with pee and collapses when it is empty.
Abnormal urothelial cells in bladder cancer spread from inner lining to bladder layers and may spread through bladder wall.
Kidneys filter blood to create urine stored in renal pelvis at middle of each kidney.
Types of Urothelial Cancer:
Non-invasive
Invasive
High-grade vs. Low-grade
Urothelial cancer ranks 10th globally with 573000 new cases and 212000 deaths in 2020. U.S. experiences high incidence with 82290 new cases every year.
Urothelial cancer is more prevalent in older men than women usually individuals with >65 years old.
Bladder cancer rates are double in White men compared to Black men. Smoking contributes to nearly half of all bladder cancer cases and increase the risk three times compared to non-smokers.
Their development is influenced by environmental risks, genetic mutations, and molecular changes in urinary tract cell growth.
Mutations in FGFR3 and HRAS are common in low-grade bladder cancer to promote abnormal cell growth and division in non-invasive tumors.
The main molecular pathway for UCs is the development of a papillary tumor in the bladder. If untreated, it can penetrate the basement membrane and spread further.
High-grade cancers progress, while low-grade cancers have unique molecular pathways and rarely progress.
Superficial bladder tumors in urothelium or lamina propria have good prognosis, with high recurrence risk but low progression to muscle-invasive cancer.
Muscle invasion in cancer predicts poor outcomes with higher chances of metastasis and cancer-related death.
High-grade tumors are more aggressive with increased risk of invasion and spreading.
They have higher chances of recurrence, progression, and mortality.
Collect details including presenting symptoms, family and medical history to understand clinical history of patient.
Acute renal failure, Severe pain from metastasis, Respiratory distress from lung metastases, Sepsis from UTI.
Urinary Tract Infection
Nephrolithiasis
Renal Cell Carcinoma
Hemorrhagic Cystitis
Ureteral Trauma
BCG instillation is effective for treatment of high-risk bladder carcinoma. It is the best intravesical therapy for CIS and T1 tumors.
BCG vaccine or chemotherapy instilled post-endoscopic resection of papillary tumors within 2 to 4 weeks
Gene therapy Nadofaragene firadenovec delivers IFNα2b gene using non-replicating adenoviral vector to bladder urothelium.
Urethrectomy for bladder cancer in men is uncommon as most achieve negative urethral margins. Delayed urethrectomy may be an option for those with positive margins.
Men with stage T2-T4 disease should undergo radical cystoprostatectomy, while women should have anterior pelvic exenteration and lymphadenectomy.
Salvage cystectomy has comparable morbidity/mortality rates to first-line radical cystectomy but limited reconstructive options due to irradiated bowel.
Urology
Patient should regularly maintain hydration level to reduce the risk.
Follow regular exercise routine to improve overall kidney function and health.
Start with low-sodium diet to manage hypertension and avoid high-protein diet to reduce the workload on the kidneys.
Patient should reduce consumption of nitrates and processed meats and increase intake of fruits and vegetables in regular diet.
Proper education and awareness about urothelial cancer should be provided and its related causes with management strategies.
Appointments with a urologist and preventing recurrence of disorder is an ongoing life-long effort.
It is effective in patients with advanced urothelial carcinoma after chemotherapy and immunotherapy.
Urology
Nadofaragene firadenovec:
It is indicated in unresponsive non-muscle invasive bladder cancer cases.
Urology
There are various surgical options available including, Transurethral Resection of Bladder Tumor (TURBT), Radical Cystectomy, Nephroureterectomy, and Intravesical Therapy.
Urology
In the initial diagnosis phase, evaluation of medical history, physical examination and imaging studies to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of Antineoplastics, FGFR Inhibitors, Anti-Nectin antibody, Gene Therapy, and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with urologist are schedule to check the improvement of patients along with treatment response.
Urothelial cancer (UC) is the most common type of bladder cancer. It occurs from urothelium lining the bladder, ureters, renal pelvis, and parts of urethra.
Bladder cancer is a common urologic cancer that originates in the urothelium mucosal layer of the bladder.
About 90% of bladder cancers are urothelial carcinoma along with 7% of kidney cancers including renal pelvis.
Bladder is a triangle-shaped organ between hipbones, above urethra and below kidneys.
Urothelium is made of cells to stretch bladder when it fills with pee and collapses when it is empty.
Abnormal urothelial cells in bladder cancer spread from inner lining to bladder layers and may spread through bladder wall.
Kidneys filter blood to create urine stored in renal pelvis at middle of each kidney.
Types of Urothelial Cancer:
Non-invasive
Invasive
High-grade vs. Low-grade
Urothelial cancer ranks 10th globally with 573000 new cases and 212000 deaths in 2020. U.S. experiences high incidence with 82290 new cases every year.
Urothelial cancer is more prevalent in older men than women usually individuals with >65 years old.
Bladder cancer rates are double in White men compared to Black men. Smoking contributes to nearly half of all bladder cancer cases and increase the risk three times compared to non-smokers.
Their development is influenced by environmental risks, genetic mutations, and molecular changes in urinary tract cell growth.
Mutations in FGFR3 and HRAS are common in low-grade bladder cancer to promote abnormal cell growth and division in non-invasive tumors.
The main molecular pathway for UCs is the development of a papillary tumor in the bladder. If untreated, it can penetrate the basement membrane and spread further.
High-grade cancers progress, while low-grade cancers have unique molecular pathways and rarely progress.
Superficial bladder tumors in urothelium or lamina propria have good prognosis, with high recurrence risk but low progression to muscle-invasive cancer.
Muscle invasion in cancer predicts poor outcomes with higher chances of metastasis and cancer-related death.
High-grade tumors are more aggressive with increased risk of invasion and spreading.
They have higher chances of recurrence, progression, and mortality.
Collect details including presenting symptoms, family and medical history to understand clinical history of patient.
Acute renal failure, Severe pain from metastasis, Respiratory distress from lung metastases, Sepsis from UTI.
Urinary Tract Infection
Nephrolithiasis
Renal Cell Carcinoma
Hemorrhagic Cystitis
Ureteral Trauma
BCG instillation is effective for treatment of high-risk bladder carcinoma. It is the best intravesical therapy for CIS and T1 tumors.
BCG vaccine or chemotherapy instilled post-endoscopic resection of papillary tumors within 2 to 4 weeks
Gene therapy Nadofaragene firadenovec delivers IFNα2b gene using non-replicating adenoviral vector to bladder urothelium.
Urethrectomy for bladder cancer in men is uncommon as most achieve negative urethral margins. Delayed urethrectomy may be an option for those with positive margins.
Men with stage T2-T4 disease should undergo radical cystoprostatectomy, while women should have anterior pelvic exenteration and lymphadenectomy.
Salvage cystectomy has comparable morbidity/mortality rates to first-line radical cystectomy but limited reconstructive options due to irradiated bowel.
Urology
Patient should regularly maintain hydration level to reduce the risk.
Follow regular exercise routine to improve overall kidney function and health.
Start with low-sodium diet to manage hypertension and avoid high-protein diet to reduce the workload on the kidneys.
Patient should reduce consumption of nitrates and processed meats and increase intake of fruits and vegetables in regular diet.
Proper education and awareness about urothelial cancer should be provided and its related causes with management strategies.
Appointments with a urologist and preventing recurrence of disorder is an ongoing life-long effort.
It is effective in patients with advanced urothelial carcinoma after chemotherapy and immunotherapy.
Urology
Nadofaragene firadenovec:
It is indicated in unresponsive non-muscle invasive bladder cancer cases.
Urology
There are various surgical options available including, Transurethral Resection of Bladder Tumor (TURBT), Radical Cystectomy, Nephroureterectomy, and Intravesical Therapy.
Urology
In the initial diagnosis phase, evaluation of medical history, physical examination and imaging studies to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of Antineoplastics, FGFR Inhibitors, Anti-Nectin antibody, Gene Therapy, and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with urologist are schedule to check the improvement of patients along with treatment response.
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