well-differentiated tumor with broad-based invasive font
marked atypia distributed on wide areas of superficial urothelium
atypia is present
no atypia but marked degenerative epithelial changes
C. atypia is present
the anterior urethra drains into the inguinal and pelvic nodes
the posterior urethra drains into the pelvic nodes
the proximal two-thirds drain into the external and internal iliac nodes
the distal one-third drains into the obturator nodes
obstructive LUTS are common presentations and occur in association with carcinoma in situ
might present as perineal abscesses and fistulae
could be asymptomatic
venereal diseases increase the risk of urethral cancers
often of high-grade sarcomas
often associated with muscularis propria invasion
due to vesical polyps occluding ureteric orifices
should be resected but not diathermized
high specificity
high sensitivity
high reliability
strong validity
0.6 - 2%
2 - 6%
6 - 10%
12 - 16%
adenocarcinoma
transitional cell carcinoma
squamous cell carcinoma
basal cell carcinoma
ascending urethrography
voiding cystourethrography
MRI
IVU
adenocarcinoma
transitional cell carcinoma
squamous cell carcinoma
comparable
obstructive uropathy
painless hematuria
pain radiating to the groin
locally advanced tumor
increase the irrigation fluid and pursue the procedure
abort the procedure and leave a urethral catheter
perform cystogram and manage accordingly
perform abdominal exploration and manage accordingly
undergo cystectomy
try mitomycin c
take a second course of BCG
take a second course of BCG + quinolones
en bloc resection involving total penectomy, cystoprostatectomy, resection of the pubic rami and urogenital diaphragm, with pelvic lymphadenectomy. In addition, creating a urinary diversion.
total penectomy involving removal of the penis, urethra, and penile root
partial penectomy involving excision of the malignant lesion with 2-cm margins
transurethral resection or fulguration
tumor stage
tumor grade
lymphovascular invasion
lymph node spread
transitional cell carcinoma
squamous cell carcinoma
adenocarcinoma
small cell carcinoma
adenocarcinoma
transitional cell carcinoma
squamous cell carcinoma
basal cell carcinoma
adenocarcinoma
transitional cell carcinoma
squamous cell carcinoma
basal cell carcinoma
continue the procedure as perforations at this site do no harm
abort the procedure and leave a urethral catheter
convert tumor removal to open method and repair the defect
perform abdominal exploration and manage accordingly
never
unlikely
likely
always
2%
5%
70%
90%
there will be no target tumor tissue to work on
post-op. hematuria interacts unfavorably with BCG composition
of the risk of systemic absorption and sepsis
of the high risk of BCG reflux to kidneys while bladder irrigation
leiomyoma
hemangioma
fibroepithelial polyp
lymphangioma
adenocarcinoma
transitional cell carcinoma
squamous cell carcinoma
basal cell carcinoma
frequently found in association with high-grade or extensive TCC
has a rate of progression to muscle invasion of 10-25%
significant areas of CIS are easily missed by routine cystoscopy
treatment begins with TURBT
immediately before operation
immediately before incision and post-operative for 1 day
immediately before incision and post-operative for 15 days
immediately before incision and post-operative for 30 days
epirubicin
mitomycin c
BCG
none of the above
irritative bladder symptoms
obstructive bladder symptoms
palpable suprapubic mass on physical examination
painless profuse hematuria
multifocality
high tumor grade and advanced stage
presence of CIS
all of the above
RB
cyclin A
HRAS
CD-44
only in females
associated with chronic irritation, polypoid cystitis, and cystitis glandularis
no risk for squamous cell carcinoma
treated with estrogen, if symptomatic
urine cytology
CT urography
cystoscopy
renal function tests