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15.01.2016

Hematuria • 10% or more have benign hematuria or hematuria of unknown cause • Symptom of bladder cancer, kidney cancer, infection, stones, etc. Clues From the History • Pyuria, bacteriuria and dysuria- suggest UTI, but beware, high grade bladder cancer causes dysuria and pyuria • URI or skin infection 10-21 days ago or more suggest post-strep or IGa nephropathy • Family history of kidney failure?
Renal Cell Carcinoma Urology, 55:31-5, 2000 • Onset age 62, 82% with localized disease• 41% T1 disease, 15% T2, 39%T3, 4% T4• Fuhrman grade 1 or 2 in 51% of patients and 3 or 4 in 45%.
Kaplan Meier Estimate of 5 Year Tumor Free Rate In Patients Receiving Vitamin Supplement and BCG Therapy For Bladder Carcinoma 100 Lamm D.
Risk factors of the 158,700 cancers diagnosed in men and 155,600 cancers diagnosed in women each year. Approximately 80-90% of patients with bladder cancer present with painless gross hematuria. Irritative bladder symptoms like burning while passing urine, urgency, increased frequency, etc. Patients with advanced disease could present with swellings and inability to pass urine too.
The best way to diagnose the bladder cancer is to do cystoscopy to have a look inside the bladder and take biopsy and also treat at the same time. Urine analysis or simple testing of the urine would show plenty of red blood cells in the urine.
Urine cytology: If a pathologist is available they can have a look at the cells found in urine to see if there is cancer. Ultrasound examination: This can diagnose the papillary growths and might give some indication of the depth of the cancer. CT scan: This is carried out in advanced centers to identify the extent of the cancer especially in advanced cancers and especially the depth of the cancer. It is important to take a separate deep biopsy during cystoscopy to find out about muscle invasion of the tumour.
Transurethral resection of Tumour: This means removing the tumour through the normal urinary passages through resectoscope and a cutting loop. Transurethral vaporization with normal saline: This is the safest method as normal saline is used that gives better vision compared to use of Glycine and has no complications due to dilution hyponatremia.
Immunotherapy with intravesical BCG: This has been used for those with what is called CIS or multiple small tumours all over the bladder that would be difficult to resect or vaporize.


Chemotherapy for TCC: Chemotherapy with medicines like Doxorubicin, Mitomycin C, Valrubicin, etc. Radical Cystectomy: Removing the entire bladder along with the lymphatics is necessary for the muscle invasive tumours.
The common treatment plan for superficial tumours is vaporization of the tumour following confirmation with resection. With 9 months of no tumour recurrence the check cystoscopies could be carried out once a year.
Similarly if they work in rubber, textile, leather, paint or chemical industry it would be good to change the environment. Although regular checkups are advised as above, when there is blood in the urine or burning while passing urine they should report immediately.
The facilities for transurethral resection of tumour, vaporization of tumour with Glycine or saline is available at the SEESHA Karunya community hospital at Karunya at the SEESHA surgical camps at Bethesda Hospital Aizawl, Sielmat Christian Hospital at Churachandpur at Manipur, Family Health Hospital at Dimapur and the other places. Available Options for Evaluation and Treatment of Urinary Tract Infections in Rural Areas – includes a free patient information PDF!
If you interesting in "Hematuria" powerpoint themes, you can download to use this powerpoint template for your own presentation template. High grade, solid, flat or in situ tumors may not be seen • Urinary cytology: 80% + sensitivity in high grade tumors with 95% specificity.
Normal cells grow to replace the damaged cells but when the repair is over, they stop growing because of contact inhibition. This is because most of the unwanted substances are excreted through the bladder and there is significant contact time with the bladder.
All patients with this classic presentation should be considered to have bladder cancer until proof to the contrary is found.
If it is positive it is helpful but negative cytological examination does not rule out cancer. These check cystoscopies continue every month till there are three negative scopies or three times there is no tumour.
Radical Cystectomy could be used for those with muscle invasive tumour who are capable of withstanding such major surgery. For viewing only, you can play with our flash based presentation viewer instead of downloading the ppt file.


Using tobacco especially smoking is the most well known agent.  Smoking is the causative agent in half the men and about a third of women. Recently some studies have shown that some dogs could be trained to identify cancers through smell. The inner lining of the bladder or transitional epithelium is loosely attached to the muscle and sometimes during surgery [that is not carried out carefully] the entire epithelium could be detached easily and this poses a serious complication.
This overcomes the problems with resectoscope as it is much easier just to touch the tumour and this causes vaporization of the tumour. Sometimes with extensive tumour when surgery is not possible this may be the only available option. The Urinary bladder cancers are from transitional cells that line the inner surface of the urinary bladder. The spread of the disease could be local, through the lymph to the nearby lymph nodes and through blood to distant places.
The good thing about this anatomy is that treatment is easy and could be carried out through normal urinary passages as long as the tumour or cancer remains confined to the inner lining.
The drawback is that it bleeds because the loop only cuts tissues and experience is necessary to resect the tumours in the bladder looking at the two dimensional monitor screen and also because the resectoscope allows movement only in one direction and the entire scope has to be moved for resection.
Methotrexate, vincristine, Adriamycin [Doxorubicin] and Cisplatin is a commonly used regime for bladder cancer [MVAC]. Changes in some genes are associated with bladder cancers and hence having it is much higher when there is a family history of bladder cancer.
Squamous cell carcinoma develops in the thin flat cells of the bladder and forms with chronic infection or irritation. It is an industrial hazard for those working in factories dealing with paints, dyes, metals and petroleum products. Water contaminated with arsenic is another factor associated with bladder cancer and water treated with chlorine also associated with increased incidence.
Infection with Shistosomiasis and any chronic irritation like long term catheters; stones, etc.



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