방광암(Bladder cancer)

목차
병태생리 진단 치료

병태생리

  • 역학 : 60~70대 남성에서 호발
  • 원인 물질 : smoking(m/i), 화학물질(aromatic amine (2-naphthylamine), Aniline dye) cyclophsophamide 장기간 투여, 방광주혈흡충 감염 
  • 병리 : transitional cell carcinonia가 가장  흔함

 



진단

  • 증상 : 육안적/현미경적 혈뇨(m/c)
  • 진단적 검사 
    1. 요세포검사 (urine cytology)
    2. 영상진단 : IVP, US, CT
    3. 방광경검사(cystoscopy) : 가장 중요한 검사, 조직검사 시행하여 확진
  • 병기(stage) : 방광암 진단 후 요도경유절제술(TURB)를 통해 방광암의 침범 깊이를 결정. 얄은암이면 더 이상 추가검사는 필요없으며, 침습암이면 원격전이 유무를 찾아야 함

 

                         

Primary Tumor(T)

TX

Primary  tumor cannot be assessed

T0

No  evidence of primary tumor

Ta

Noninvasive  papillary carcinoma

Tis

Carcinoma  in situ: "flat tumor"

T1

Tumor  invades subepithelial connective tissue

T2

Tumor  invades muscularis propria

pT2a

Tumor  invades superficial muscularis propria (inner half)

pT2b

Tumor  invades deep muscularis propria (outer half)

T3

Tumor  invades perivesical tissue

pT3a

Microscopically

pT3b

Macroscopically  (extravesical mass)

T4

Tumor  invades prostatic stroma, uterus, vagina

T4b

Tumor  invades pelvic wall, abdominal wall

           

Regional  Lymph Nodes(N)

Regional  lymph nodes include both primary and secondary drainage regions. All other  nodes above the aortic bifurcation are considered distant lymph nodes.

NX

Lymph  nodes cannot be assessed

N0

No  lymph node metastasis

N1

single  regional lymph node metastasis in the true pelvis

(hypogastric,  obturator, external iliac, or presacral lymph node)

N2

multiple  regional lymph node metastasis in the true pelvis

(hypogastric,  obturator, external iliac, or presacral lymph node metastasis)

N3

Lymph  node metastasis to the common lilac lymph nodes


Distant Metasyasis (M)
M0   No distant mestastasis
M1Distant metastasis


ANATOMIC STAGE/PROGNOSTIC GROUPS

Stage 0a

Ta

N0

M0

Stage 0is

Tis

N0

M0

Stage I

T1

N0

M0

Stage II

T2a

N0

M0

T2b

N0

M0

Stage III

T3a

N0

M0

T3b

N0

M0

T4a

N0

M0

Stage IV

T4b

N0

M0

Any T

N1~3

M0

Any T

Any N

M1

 



치료

: 진단 및 치료 방법

  1. Superficial bladder tumor : TURB(transurethral resection of bladder tumor) ± intravesical therapy (방광내 주입치료)
    방광내 주입 물질(얕은 암의 재발 방지목적) : BCG (m/c), 항암제(mitomycin C, gemcitabine), 면역치료제(IFN)
  2. Invasive bladder tumor : Radical Cystectomy ± systemic chemotherapy ± RTx. 
  3. Metastatic bladder tumor : systemic chemotherapy

 

참고자료

  • 비뇨기과학 4판.  p299~304
  • NCCN Clinical Practice Guidelines in Oncology : Bladder Cancer.
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