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
- 요세포검사 (urine cytology)
- 영상진단 : IVP, US, CT
- 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 |
M1 | Distant 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
- 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) - Invasive bladder tumor : Radical Cystectomy ± systemic chemotherapy ± RTx.
- Metastatic bladder tumor : systemic chemotherapy
참고자료
- 비뇨기과학 4판. p299~304
- NCCN Clinical Practice Guidelines in Oncology : Bladder Cancer.