Transitional cell carcinom

a
Ke Xu

Epidemiology
Worldwide incidence of 151/100,000 in 2012 (mortality 52.4) (F
erlay, Steliarova-Foucher et al. 2013)
Male more commonly affected than female with ratio of 3.6
2300+ cases in 2009 in Australia (AIHW)
From 1985 to 2005, incidence of bladder cancer in US increase
d by over 50% (Jemal, Siegel et al. 2010)
Typically diagnosed in older individuals, median age 69M, 71F
In elderly man, bladder cancer is 2nd most prevalent after pros
tate
At presentation, 70-80% cases are non-muscle invasive

Risk factors
Urothelial cell is at increased risk of exposure to environmental
carcinogens
Large number of chemical carcinogens, aromatic amines, phen
yls (Kogevinas, t Mannetje et al. 2003)
Other occupational carcinogens include paint, hair dyes, ?exha
ust, ?firefighting
Cigarette smoking, >60 carcinogenic compounds; HR 4.06 in c
urrent smokers, 2.22 in formal smokers (Freedman, Silverman
et al. 2011)

Risk factors
Chlorination of water; meta-analysis of 6 case control studies s
howed moderately increased risk in men (OR 1.4, 1.1-1.9), NS i
n women (Villanueva, Fernandez et al. 2003)
Total daily fluid intake was found to be inversely assocaited wit
h trisk of bladder cancer (RR 0.51, 0.32-0.80 if daily intake >2.5
L) (Michaud, Spiegelman et al. 1999) health professional follow
up study
Iatrogenic radiation, cyclophosphamide
Schistosomiasis

Pathology
Gross morphological patte
rns of bladder tumours
Two distinctive types of pr
ecursor lesions, non-invasi
ve papillary tumours, flat
non-invasive urothelial car
cinoma (CIS)

Pathology

Pathology
WHO/ISUP classification
Urothelial papilloma
Urothelial neoplasm of low malignant potential
Papillary urothelial carcinoma, low grade
Papillary urothelial carcinoma, high grade
CIS is considered high grade

Pathophysiology
Commonly have chromosome 9 abnormality (9q-, 9p-, monoso
my 9)
9p21- leads to loss of INK4a, which encodes inhibitor of a cycli
n dependent kinase
Other common mutations include 17p-, 13q-, 11p-, 14q 17p abnormalities are associated with p53 mutation