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8/13/2019 TCC Haris New

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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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