Bladder Flashcards
What is the peak age for bladder cancer?
70 years or older (peak age of 73)
What is the male to female ratio for bladder cancer?
Approximately 4:1
Which racial group is more likely to develop bladder cancer?
Caucasian Americans are two times more likely than African Americans
What is the most important risk factor for bladder cancer?
Smoking
How much more likely are smokers to develop bladder cancer compared to non-smokers?
At least 3 times as likely
What percentage of bladder cancer patients experience gross painless hematuria?
75-80%
What is gross hematuria?
Visible blood in urine that turns red.
What is microscopic hematuria?
Blood in urine that may not be seen with the naked eye.
What are common symptoms of bladder cancer?
Blood in urine, urgency, and dysuria.
What is included in the complete history and physical exam (H&P)?
It includes a rectal and pelvic exam.
What imaging is performed in the diagnostic workup?
A chest X-ray (CXR) is performed.
What tests are included in the diagnostic workup for males?
CXR and urinalysis.
What areas are examined in the male diagnostic workup?
Urethra, prostate, and bladder.
What blood tests are included in the diagnostic workup?
Complete blood count (CBC) and liver function test.
What procedure is done for diagnosis?
Cystoscopy.
What is the purpose of a biopsy in the diagnostic workup?
It is done for diagnosis.
What fluid is involved in the cystoscopy procedure?
Fluid filling the bladder.
What anatomical areas are relevant in the female diagnostic workup?
Uterus, vagina, anus, and rectum.
What type of cancer is mentioned in the diagnostic workup?
Bladder cancer.
What are the three major types of bladder cancer?
- Transitional cell carcinoma (Urothelial carcinoma)
- Squamous cell carcinomas
- Adenocarcinomas
Which type of bladder cancer is the most common?
Transitional cell carcinoma (Urothelial carcinoma) is by far the most common type of bladder cancer.
Where do most bladder cancers start?
Most bladder cancers start in the innermost lining of the bladder, called the urothelium or transitional epithelium.
What happens as bladder cancer grows into or through the bladder wall layers?
As the cancer grows into or through the other layers in the bladder wall, it has a higher stage, becomes more advanced, and can be harder to treat.
What are the routes of spread for bladder cancer?
Lymphatic drainage to: External iliac, Internal iliac, Presacral lymph nodes
What is the main advantage of Partial Cystectomy?
The person keeps their bladder and doesn’t need reconstructive surgery.
What is a Cystectomy?
A surgical operation that removes all or part of the bladder, depending on the stage of cancer.
What does Radical Cystectomy involve?
It removes the entire bladder and nearby lymph nodes, as well as the prostate and seminal vesicles in men, and the ovaries, fallopian tubes, uterus, cervix, and a small part of the vagina in women.
What is Bacillus Calmette-Guerin (BCG)?
The most common intravesical immunotherapy for treating early-stage bladder cancer.
How is BCG administered?
Through intravesical therapy, where the doctor puts a liquid drug directly into the bladder.
What are common chemotherapy drugs used with radiation for bladder cancer?
Cisplatin, Cisplatin plus fluorouracil (5-FU), and Mitomycin with 5-FU.
What position is the patient in during bladder setup for simulation?
The patient is in the supine position.
What is inserted into the bladder during the setup?
A Foley catheter is inserted into the bladder using sterile technique.
What is injected into the bladder to outline its posterior portion?
Iodinated contrast is injected.
What is the preferred bladder state during scanning and treatment?
Scan bladder FULL, but treat bladder EMPTY.
Why is daily CBCT imaging used in bladder cancer treatment?
To reduce the field size from 2 to 3 cm down to 1 to 1.6 cm and significantly reduce radiation-induced complications.
What is the typical radiation treatment dose for the larger pelvic field including the bladder and pelvic lymph nodes?
The typical dose is 45 to 50 Gray at 180 cGy per day.
What is the preoperative radiation dose for bladder cancer?
The preoperative dose is 45-50 Gy at 1.8 Gy/fraction.
What is the postoperative radiation dose for bladder cancer?
The postoperative dose is 65-70 Gy at 1.8 Gy/fraction.
What is the radiation dose for combined EBRT and chemotherapy?
The dose for EBRT and chemotherapy is 45-65 Gy at 1.8 Gy/fraction.
