CENTRO ESTATAL DE ONCOLOGA. TERCERA JORNADA DE ONCOLOGA.

TUMORES GENITOURINARIOS.

Dr. Rodolfo Woller Vzquez.

AGRADECE AL DR ERNESTO RIVERA CLAISSE, DIRECTOR DEL CENTRO ESTATAL DE ONCOLOGA POR SU AMABLE INVITACIN A TAN IMPORTANTE EVENTO DE XV ANIVERSARIO Y NOS HAYA PERMITIDO INTRODUCIR TEMAS DE NUESTRA ESPECIALIDAD EN ESTA TERCERA JORNADA ACADMICA. RESALTAMOS EL GRAN INTERS DE SU DIRECTOR Y TAMBIEN FUNDADOR POR SU PREOCUPACIN CONSTANTE EN COLOCAR A LA VANGUARDIA A ESTA MUY RECONOCIDA Y NOBLE INSTITUCIN.

TUMORES GENITOURINARIOS

TUMORES GENITOURINARIOS

DR. CARLOS LEOS GALLEGOS. ISSSTE. CA DE PROSTATA. DR. ARMANDO BALTAZARES LPEZ. IMSS. CA DE PROSTATA. DR. CARLOS LEOS ACOSTA. HGE DE SSA. CA TESTICULAR DR. RODOLFO WOLLER VAZQUEZ. ISSSTESON. H. MILITAR, SEDENA. CANCER DE VEJIGA

CANCER (Global)
FRECUENCIA

USA MEXICO (incan) 1 596 670 127 930

MORTALIDAD 38 % (2. Causa) 58% SOBREVIVENCIA ( 5 a.) 68 %

CNCER DE VEJIGA
TERCERA JORNADA ONCOLGICA DESARROLLO DE CA POR SITIO
TODOS ---------------------------1 EN 2 PROSTATA--------------------- -1 EN 6 PULMN Y BRONQUIOS------1 EN 13 COLON Y RECTO----------------1 EN 19 VEJIGA----------------------------1 EN 26 LINFOMA NO HODKING-------1 EN 45 MELANOMA---------------------1 EN 55

RIN----------------------------1 EN 55
Leucemia 1 en 67, Boca 1 en 77, Estomago 1 en 90, TESTICULO, 1 en 500

Tumores Genitourinarios
INCIDENCIA

TUMORES UROLOGICOS Mortalidad

TUMORES GENITOURINARIOS.
FRECUENCIA ) Ca de Prostata, Vejiga, Rin, Testiculo y Pene MAYOR MORTALIDAD-ENF.AVANZADA: Testiculo-25 % Rin- 20 % Vejiga 6.5 % Prostata-5.5 % Pene-3 %

COLEGIO SONORENSE DE UROLOGIA

PAPEL DEL UROLOGO EN TGU
Tumores Benignos. T. Malignos: Localizado------Ciruga---------Urlogo Radioterapia-----RadTx. Loc. AvanzadoCiruga--------Urologo Radioterapia-----RadTx. QuimioTx-------Urologo? Avanzada------Ciruga paliativa, QuimioTx, Cuidados Paliativos----?

TUMORES GENITOURINARIOS
PAPEL DEL UROLOGO
TUMOR LOCALIZADO
CIRUGIA RADIOTERAPIA
UROLOGO RADIOTERAPEUTA

CIRUGA.

UROLOGO

LOCALMENTE
AVANZADO

RADIOTX

RADIOTX.
UROLOGO? ONCOLOGO?

QUIMIOX
CIR. PALIATIVA.

T. AVANZADO

QUIMIOTX CUIDADOS PALIATIVOS

??

CENTRO ESTATAL DE ONCOLOGA TERCERA JORNADA DE ONCOLOGA TUMORES GENITOURINARIOS Dr. Rodolfo Woller Vzquez

CA DE VEJIGA. patologa
Ca de Cels. Trans. 90 % Ca de Cels. escamosas 5%, Adenocarcinoma 2% Carcinoma Urotelial 70 % A 80% NO invasivos.

CANCER DE VEJIGA

CANCER DE VEJIGA

CANCER DE VEJIGA
UROTELIO:
REVESTIMIENTO DE VEJIGA DE CELULAS

TRANSICIONALES TRANSFORMACIN EN TUMORES BENIGNOS Y MALIGNOS (PLURICRONOTOPICIDAD) TUMORES CELULAS TRANSICIONALES

CA DE VEJIGA
Ca de Urotelio 90 %

Ca de cels. escamosas 5%, Adenocarcinoma 2%

CANCER DE UROTELIO.
Vejiga 90 % Pelvis renal 8% Ureter y Uretra 2 %
No Invasivo Invasivos Cis

INCIDENCIA

CA. DE CELS. TRANCISIONALES90%

75%-80% 20 % 10%

CANCER DE VEJIGA.
INCIDENCIA 7 % (51,230 H 17,580 M) CA EN GRAL. 9a. Causa ( 357 000) 13a. CAUSA DE MUERTES (145 000) CUARTA CAUSA DE CA (hombres) 11a. CAUSA EN MUJERES ENFERMEDAD LETAL: 3 % Muertes (14 100)

PROBABILIDAD CA VEJIGA : 1 en 26 (hombres) 1 en 86 (mujeres) Disminuye: Raza Blanca 3.5%, afro-am, hispanos (5%)

CANCER DE VEJIGA. Incidencia.

FRECUENTE EN HOMBRES (Rel. 3 a 1) EDAD 70 a. (Raro 40 a.) DIFERENCIAS GEOGRAFICAS: Europa, medio oriente, 14-24 % AFRICA Y EGIPTO 70% (ca cels esc)

CNCER DE VEJIGA
FACTORES AMBIENTALES
ANORMALIDADES GENTICAS

CANCER DE VEJIGA ETIOLOGA

TABAQUISMO OCUPACION FXS AMBIENTALES OTROS (Genes, ingesta lquidos, dieta)

CALCULOS, FXS. LOCALES PARASITOS IRRITATIVOS INFECCIONES, PVH,

CNCER DE VEJIGA. Etiologa.

FACTORES AMBIENTALES: Tabaquismo. Factor ms comn, mal pronostico,

Grado alto Ocupacin: Aminas aromticas; hule, poliuretano, aluminio, imprenta, fund. Metales Anilinas; trabajadores ind. agricolas, colorantes,herbicidas, barnices, explosivos, pint sintticas . .

TABAQUISMO

CANCER DE VEJIGA
Riesgo de Ca ----2.77 Factor en 40% a 60 % Hombres

TABAQUISMO

30%

Mujeres

Mortalidad: 30% Hombres 46% Paises Desarrollados 28% P menos desarrollo 13% Mujeres, 29% P. Desarrollados,3% Poco dearrolladoss

CA DE VEJIGA. Etiologa.
Ocupacin: Aminas aromticas; hule, poliuretano, aluminio, imprenta, fund. Metales Anilinas; trabajadores ind. agricolas, colorantes,herbicidas, barnices, explosivos, pint sintticas

CA DE VEJIGA. Etiologa

CA DE VEJIGA. Etiologa

CNCER DE VEJIGA. Etiologa.

Fxs. Irritativos Locales: Otros:

Clculos, Parsitos. Infecciones (Bacterias, PVH)

Genes, Dieta Baja ingesta de lquidos, caf o t, Edulcurantes, Abuso de analgsicos, Herencia.

CANCER DE VEJIGA ETIOLOGA

TABAQUISMO OCUPACION FXS AMBIENTALES OTROS (Genes, ingesta lquidos, dieta)

CALCULOS, FXS. LOCALES PARASITOS IRRITATIVOS INFECCIONES, PVH,

CA DE VEJIGA Etiologa.
Otros
:

Genes, Dieta Baja ingesta de lquidos, caf o t, . Edulcurantes, Abuso de analgsicos, Herencia.

CANCER DE VEJIGA ETIOLOGIA

GENES

EDULCURANTES

SUPERFICIALES

ANALGESICOS

CA DE VEJIGA. tumorogenesis

CA DE VEJIGA

PLEOCRONOTOPOCIDAD

Origin, Recurrence, and Invasion l Primary urothelial cancer is an environmentally caused tumor that recurs because of persistent genetic changes within the normal-appearing urothelium. l Recurrent urothelial tumors occur by activation of nascent normal cells that have some genetic instability by environmental factors and tumor seeding during transurethral tumor resection. l Accumulation of genetic changes leads to cellular proliferation, loss of cellcell adhesion, and invasion. l The depth of invasion and grade of the tumor are the best prognostic determinants of urothelial cancer, but molecular assays are likely to be incorporated into future staging schemas.

CA DE VEJIGA
CATEGORIAS DE TUMORES VESICALES

Tumores papilares TaT1 (cncer de vejiga sin invasin muscular) 75%-80% Carcinoma in situ (CIS) 1%-10% (primario) Tumores vesicales con invasin muscular. 20%

CNCER VEJIGA

CANCER DE VEJIGA
T Tumor Primario

CLASIFICACION

Ta Carcinoma Papilar No invasivo Tis Carcinoma in situ T1 Tumor invade a lmina propia

CANCER DE VEJIGA

CLASIFICACION

T2 Tumor invade capa muscular

T2a Invasin a capa superficial T2b Invasion a capa profunda mitad Externa

CANCER DE VEJIGA

CLASIFICACION

T3 Invasin a tejido perivesical

T3a Invasin microscpica T3b Invasin macroscpica

T4 Invasin a prstata, vagina, tero,

(T4a) pelvis, pared abdominal(T4b).

CA VESICAL NO INVASIVO
CARACTERSTICAS DE GRADO
OMS 2004 PAPILOMA UROTELIAL
Neoplasia

Papilar Urotelial de bajo potencial maligno (PUNLMP) Carcinoma Urotelial papilar de bajo grado Carcinoma Urotelial papilar de alto grado.

CA DE VEJIGA No Invasivo.

CA DE VEJIGA

PROGRESION Y RECIDIVA

NEOPLASIA UROTELIAL PAPILAR DE BAJO

POTENCIAL MALIGNO Pueden recurrir, Raramente invaden. CARCINOMA DE BAJO GRADO Recurren mas 60%. Invasin menos 10% CARCINOMA DE ALTO GRADO Recurren; Invasin yProgresion 50% . CA. PAPILAR ALTO GRADO MAS Tis---Mismo %

CA DE VEJIGA. Diagnstico

CA DE VEJIGA. Diagnstico

CANCER DE VEJIGA
DIAGNOSTICO

NO INVASIVO.

HEMATURIA EXPLORACIN
TAC ECOGRAFA CITOLOGIA URINARIA ANALISIS MOLECULARES

CANCER DE VEJIGA
DIAGNOSTICO

NO INVASIVO.

HEMATURIA EXPLORACIN

CITOLOGIA URINARIA

95% especificidad 40%-60% sensibilidad 82% en alto riesgo ECOGRAFA UROTOMOGRAFIA CISTOSCOPIA

CANCER DE VEJIGA

DETECCION

Painless gross hematuria occurs in 85% of patients with bladder cancer and requires a complete evaluation that includes cystoscopy, urine cytology, CT scan, and a PSA blood test. Patients with microscopic hematuria require a full evaluation, but low-risk patients do not require repeat evaluations. High-risk individuals primarily are those with a smoking history and should be evaluated every 6 months. lWhite light cystoscopy with random bladder biopsies is the gold standard for tumor detection, but blue light cystoscopy may be an adjunct. There are various urine markers that evaluate secreted proteins or shed cells in the hope of noninvasively detecting bladder cancer. To date, none of these markers have a high enough sensitivity or specificity to replace office cystoscopy.

CA DE VEJIGA Diagnostico

CANCER DE VEJIGA
DIAGNOSTICO

NO INVASIVO.

HEMATURIA EXPLORACIN TAC ECOGRAFA CITOLOGIA URINARIA

BIOPSIAS DE VEJIGA: cono fro, citologa positiva, aspecto no papilar, sospecha de ca in situ (2% en t. bajo riesgo), no determina tx intraveical adyuvante.

CANCER DE VEJIGA Diagnstico

CANCER DE VEJIGA
MARCADORES MOLECULARES

CA DE VEJIGA

RTU DE TUMOR

CA DE VEJIGA RTU DE TUMOR

CA DE VEJIGA

DIAGNSTICO

RTU DE TUMOR SEGUNDA RTU INFORME DEL ANATOMOPATOLOGO

CA DE VEJIGA

SEGUNDA RTU

TUMOR RESIDUAL POSRTU (incompleta)

INICIAL ENFEREMDAD PERSISTENTE 33%-53% T1 Ta ALTO GRADO. SUBCLASIFICACIN DE ESTADIO REAL(18%34%) BIOPSIA SIN TEJIDO MUSCULAR (Ta alto Grado, T1) INVASIN MUSC. (10%) NO SE REALIZA TUMORES MULTIPLES GRANDES AUMENTA SOBREVIDA SIN RECIDIVAS REALIZARLA 2- 6 SEMANAS POSRTU INICIAL

CA DE VEJIGA
EXAMEN CLAVE

INFORME HISTOPATOLOGICO

ESPECIFICAR GRADO, PROFUNDIDAD DE LESIN INFORMAR PRESENCIA O NO DE LAMINA PROPIA Y MUSCULO

CA DE VEJIGA

FXS CLINICOS

RECIDIVA Y PROGRESION Numero de tumores Tamao del tumor Frecuencia recidiva anterior Categora T Cis concomitante Grado del tumor Puntuacin Total: 0-17 (recidiva) 0-23 (progresin

Clculo de Recurrencia y Progresion Factor No. de tumores Unico 2 a7 >8 Dimetro de tumor < 3 cm > 3 cm Recurrencia Progresin

0 3 6

0 3 3

0 3

0 3

Recurrencia previa Recidiva Progresin Primario 0 0 < 1 rec/ao 2 2 1 rec./aor 4 2 Categoria Ta T1

0 1

1 4

Cis concomitante No

Recidiva 0

Progresin 0

Si
Grade (1973 OMS) G1

G2
G3 Total Score

1
2 0 - 17

0
5 0 - 23

CA DE VEJIGA PRONOSTICO.
MAYOR RIESGO DE RECURRENCIA:

Una recurrencia/Ao, lesiones mltiples,

MAYOR RIESGO DE INVASIN:

Grado, Cis, T1, ms de dos lesiones

MISMO RIESGO: ms 3 cms. tamao

CA DE VEJIGA

PRONOSTICO

Origin, Recurrence, and Invasion l Primary urothelial cancer is an environmentally caused tumor that recurs because of persistent genetic changes within the normal-appearing urothelium. l Recurrent urothelial tumors occur by activation of nascent normal cells that have some genetic instability by environmental factors and tumor seeding during transurethral tumor resection. l Accumulation of genetic changes leads to cellular proliferation, loss of cellcell adhesion, and invasion. l The depth of invasion and grade of the tumor are the best prognostic determinants of urothelial cancer, but molecular assays are likely to be incorporated into future staging schemas.

Estimates of Disease Progression in NonMuscleTUMOR TYPE % RELATIVE FREQUENCY % PROGRESSION % DEATHS Noninvasive Papilloma 10 0-1 0 Papillary urothelial neoplasm of low malignant potential 20 3 0-1 Papillary cancer low grade (TaG1) 20 5-10 1-5 Papillary cancer high grade (TaG3) 30 15-40 10-25

FREQUENCY % PROGRESSION % DEATHS Noninvasive Papilloma 10 0-1 0 Papillary urothelial neoplasm of low
malignant potential 20 3 0-1 Papillary cancer low grade (TaG1) 20 5-10 1-5 Papillary cancer high grade (TaG3) 30 15-40 10-25

CA DE VEJIGA. tumorogenesis

CA DE VEJIGA.

HISTORIA NATURAL

Ta BAJO GRADO RARAMENTE PROGRESAN

(5%), Recurren 50%-70% Ta alto grado (6.9%) igual a alto riesgo Cis invade 40%-83% sin tx. T1 alto grado recurren 80% progresan 50% a 3 aos Ta T1 50%-70% Recurren en 5 aos y 26% Mueren

ESTADIO T1 CANCER RESIDUAL 30% PROGRESION7%/AO

CA DE VEJIGA

HISTORIA NATURAL

CA IN SITU 20%-34 % progresan (Primario)

42%-83% invaden acompaando a T1 o Ta

CA DE VEJIGA PRONOSTICO
ALTO GRADO Ta G3 RECURREN PROGRESAN 5 a. 10 a. MUEREN 10 a. 3 a. 20% 30%-40% 10%-26%

CA DE VEJIGA PRONOSTICO
T1 ALTO GRADO Recurrencia

Progresan Cis concomitante

1 ao 3 aos 5 aos 5 aos

50% 80% 90% 50% 80%

CA DE VEJIGA

Pronstico

CANCER DE VEJIGA
QUIMIOTERAPIA INTRAVESICAL ADYUVANTE
MMC, THIOTEPA, EPIRUBICINA (80 mgs), GEMCITABINA

PREVIENEN IMPLANTACIN DE CELS. TUMORALES

PREFERENTEMENTE USADA EN PAC . BAJO RIESGO DE RECURRENCIA. MMC(40 mgs-UNA DOSIS, 6-24 HS DESPUES RTU. T1 ALTO GRADO, 6 SEM (DUDOSO) NO IMPACTA EN RIESGO DE PROGRESIN

CANCER DE VEJIGA

QUIMIOTERAPIA

Intravesical Chemotherapy l Intravesical chemotherapy has a clear impact on tumor recurrence when immediately instilled after TURBT and in the adjuvant setting. There is no clear evidence of an impact on progression. l Combinations of various chemotherapeutic agents and chemotherapy combined with BCG have not demonstrated major benefit combined with single-agent treatment, with the exception of interferon. l In general, side effects of chemotherapy tend to be less common and less severe than those for BCG, but BCG is more efficacious.

CA DE VEJIGA

INMUNOTERAPIA

RESPUESTA INMUNE MASIVA (CITOKINAS) INICIO 2-4 SEMA PORSRTU RETENER EN VEJIGA 2 HS RIESGO INTERM ALTO DE RECIDIVA, RIESGO INTERM. PROGRESION: 1 AO

RIESGO ALTO DE PROGRESIN (post-quimioterapia) BCG (3 AOS)

CANCER DE VEJIGA

INMUNOTERAPIA

Immunotherapy l Intravesical BCG has higher efficacy than intravesical chemotherapy. l BCG should be used cautiously for patients with low-risk disease because of concern about side effects. l BCG is the only agent shown to delay or reduce high-grade tumor progression. l The optimum dosage and the treatment schedule for BCG are undetermined, but results are better with maintenance therapy, if tolerated. l BCG is contraindicated in the setting of a disrupted urothelium because of the risk of intravasation and septic death. l Interferon- has not been shown to have benefit compared with BCG for primary treatment but appears to work well in combination with low-dose BCG, especially for salvage

CA DE VEJIGA

ENF. REFRACTARIA

Management of Refractory Disease l Patients who fail to respond to an initial course of intravesical therapy after TURBT are at high risk of recurrence or progression. l Failure after initial chemotherapy or BCG is most appropriately treated with a subsequent course of BCG because its efficacy in this setting is significantly greater than that of chemotherapy. l Patients at high risk for progression should be considered for cystectomy. l Failure to respond to an initial course of intravesical therapy is occasion to reconsider cystectomy. Failure to respond to a second course is an indication for immediate cystectomy unless contraindicated or the patient chooses to pursue clinical trials.

CISTECTOM

IA INMEDIATA

FALLA DE BCG RIESGO MAYOR DE PROGRESIN T. NO INV.

CA RECURRENTE
CISTOSCOPIA DE SEGUIMIENTO
Riesgo bajo de recidiva y progresin
3 meses.

NEGATIVA- 9. mes despues una vez/ao, 5 aos

Riesgo alto de progresin:

Cistoscopia y citologia en 3 meses. NEGATIVA, cistoscopias y citologias cada 3 m. en 2 aos, cada4 meses en tercer ao, cada 6 meses - 5 aos, anualmente.

Riesgo intermedio de progresin Esquema Intermedio cistoscopia y citologia,

CA DE VEJIGA
VIGILANCIA Y PREVENCION
Surveillance and Prevention l Cystoscopy is the hallmark of surveillance. The optimum schedule is undefined but may be individualized on the basis of risk. l Table 818 demonstrates reasonable surveillance protocols based on clinical scenarios. Guidelines for management are shown in Table 819. l A number of tumor markers have shown the ability to improve upon the sensitivity of cytology, but specificity is lower for most. l Increased fluids, smoking cessation, and a low-fat diet are recommended.

CA DE VEJIGA Pronstico

CA VESICAL

Manejo

Pathologic, Morphologic and Clinical

atures Accurate determination of stage and grade Surgical quality TURBT and bladder biopsies Recommend rereview and 2nd TUR for T1G3 Variant histology: micropapillary Focality single vs. multiple Presence of CIS Age Status at 3 month followup Size Future: Molecular profiling

CA DE VEJIGA

TX INTRAVESICAL TaG3, Cis, T1G3 78%

PACIENTES CON GRANDES Y MULTIPLES TUMORES (MAS DE 3 CMS) Y ALTAMENTE RECURRENTES (MAS DE UNA RECURRENCIA POR AO) TIENEN MAS RIESGO DE RECURRENCIA MIENTRAS QUE PACIENTES CON TUMORES ESTADIO T1, ALTO GRADO Y Cis , TIENEN EL MAYOR RIESGO DE PROGRESIN.

Table 4: Probability of recurrence and progression according to total score Recurrence Prob. Prob. Recurrence score recurrence recurrence risk group 1 year 5 years 0 15% 31% Low risk 1-4 24% 46% Intermediate risk 5-9 38% 62% 10-17 61% 78% High risk Progression Prob. Prob. Progression score progression progression risk group 1 year 5 years 0 0.2% 0.8% Low risk 2-6 1% 6% Intermediate risk 7-13 5% 17% 14-23 17% 45% High risk Note: electronic calculators for Tables 3 and 4 are availab at http://www.eortc.be/tools/bladdercalculator/

CA DE VEJIGA SEGUIMIENTO
a. The prompt detection of muscle invasive and high-grade non-muscle invasive recurrences is critical since a delay in diagnosis and therapy threatens a patients life. b. Tumour recurrence in the low-risk group is nearly always low stage and low grade. Small, non-invasive (Ta), lowgrade papillary recurrences do not present an immediate danger to the patient and their early detection is not essential for successful therapy. c. The result of the first cystoscopy after TUR at 3 months is a very important prognostic factor for recurrence and for progression. The first cystoscopy should thus always be performed 3 months after TUR in all patients with nonmuscle invasive bladder tumour.

CA VESICAL

CISTOSCOPIA DE SEGUIMIENTO

Recommendations for follow-up cystoscopy Patients with tumours at low risk of recurrence and progression should have a cystoscopy at 3 months. If negative, the following cystoscopy is advised at 9 months and consequently yearly for 5 years. (Grade of recommendation: C) Patients with tumours at high risk of progression should have a cystoscopy and urinary cytology at 3 months. If negative, the following cystoscopies and cytologies should be repeated every 3 months for a period of 2 years, every 4 months in the third year, every 6 months thereafter until 5 years, and yearly thereafter. A yearly exploration of the upper tract is recommended. (Grade of recommendation: C) Patients with intermediate-risk of progression (about one-third of all patients) should have an in-between followup scheme using cystoscopy and cytology, adapted according to personal and subjective factors. (Grade of recommendation: C)

CA DE VEJIGA Invasivo

Consideraciones Oncolgicas,
CA P y CA TEST.

CA. VEJIGA y RIN

DETECCIN TARDA

DETECCIN TEMPRANA Marcadores tumorales Conciencia de enf. Letalidad prevenible Propaganda, Evolucin lenta, benignos

Hematuria, No previsible, Letales No conciencia de enf. Propaganda, Ocupacional

TUMORES

GENITOURINARIOS

CONSIDERACIONES ONCLOGICAS:

Ca P. TUMOR MAS COMUN (33 %) Ca de VEJIGA OCUPA CUARTO LUGAR (7 %) CaP , 2. Causa de fallecimientos (10 %) Ca de VEJIGA 9. Causa de fallecimientos (3%) AMBOS DEL HOMBRE VIEJO (Ca de VEJIGA con relacin 3 a 1)

CA DE VEJIGA Diag. Cistoscopico

CA VESICAL. Recurrente

Recurrent Tumors A hallmark of urothelial cancer is the high recurrence rate that approaches 80% for high malignant potential, non muscle-invasive bladder cancer

CA DE VEJIGA. Marcadores

CA DE VEJIGA INVASIVO

TUMORES GENITOURINARIOS
MORTALIDAD EN ETAPAS AVANZADAS

Testiculo-25 % Rin-20 % Vejiga-6.5 % Prstata-5.5% Pene-3 %

TUMORES DE UROTELIO
ETIOLOGIA:
Tabaquismo, Factores ocupacionales, Factores irritativos locales, Carcinogenicos, Radioterapia, Otros: Genes, baja ingesta de lquidos, caf o t, edulcurantes, abuso de analgsicos, herencia.

CA DE VEJIGA. Etiologa

CA DE VEJIGA. Diagnstico

CA DE VEJIGA. Diagnstico
HEMATURIA

OBJETIVOS: GENERAL, Centro de Referencia

ESPECIFICOS: COADYUVAR en mejor atencin y beneficio a los pacientes con neoplasias, CONCIENTIZAR de la importancia y necesidad de trabajar local, interinstitucional y multidisciplinariamente para OBTENER mejores resultados diagnticos, teraputicos y controles estadisticos en la Regin.

TUMORES GENITOURINARIOS
CONSECUENCIA: Incremento en Quimioterapia

CANCER DE VEJIGA Diagnstico

CA. DE VEJIGA
RESECCION TRANSURETRAL

MULTIFOCALIDAD TAMAO TUMORAL TUMORES PREVIOS PROFUNDIDAD PRESENCIA DE CA IN SITU TUMORES PREVIOS TIEMPO DE SEGUIMIENTO