Bladder and Testicular Cancer Flashcards
What type of cancer is bladder cancer usually?
90% are transitional cell carcinoma, 7% are squamous cell carcinoma – invasive and related to Schistosomiasis (swimming in Africa). Adenocarcinoma is rare 2% - invasive usually occurring at the trigone.
Where does bladder cancer spread to?
Metastatic bladder cancer it usually spreads to the lymph nodes, lungs, liver and bones.
What are the risk factors for bladder cancer?
Smoking is the main risk factor
Male
Hydrocarbons such as 2-Naphthylamine or benzidine exposure in dyes
Any profession that works with heavy oils or rubber (road layers, roofers etc.)
Cyclophosphamide
Prior radiotherapy
Associated with long term catheters, recurrent UTI and bladder stones
Schistosomiasis in endemic areas (north Africa)
What are the signs and symptoms of bladder cancer?
Painless Haematuria
Recurrent UTIs
Voiding irritability
What investigations should be done in suspected bladder cancer?
Urine microscopy
Diagnosis by flexible cystoscopy for haematuria (also CT urogram) – biopsy pr TURBT
MRI for staging
How is bladder cancer staged?
Ta – Non-invasive papillary carcinoma
Tis – carcinoma in situ
T1 – lamina propria
T2 – Muscularis propria
T3a – peri vesical fat involvement
T3b – outside of the peri vesical fat
T4 – adjacent organs
N1 – single regional lymph node in the true pelvis
N2 – multiple regional lymph nodes in the true pelvis
N3 – disease present in common iliac nodes
M1 – metastasis
What is the management for bladder cancer?
TURBT (trans urethral resection of bladder tumour)
This allows histological grading and staging
Consider doses of intravesical mitomycin or BCG to reduce recurrence .BCG regimen – live attenuated mycobacterium bovis stimulates a type IV hypersensitivity reaction that activates immune system to tumour antigens reducing progression. Side effects of this: dysuria, frequency, urgency, UTI, haematuria and ureteric stenosis
If all else fails, then cystectomy –removal of bladder and prostate in males and in females removal of bladder, uterus, tubes, ovaries and anterior vaginal wall. Both get pelvic lymph node dissection.
Or the patient can be offered radiotherapy.
Adjuvant and/or Neo-adjuvant chemotherapy can be offered
How are bladders remodeled post cystectomty?
Post Cystectomy remodelling
Ileal conduit – ureters connected to section of small bowl and brought out as a stoma which the urine drains into.
Neobladder – ureters connected to new bladder made from small bowl. Must be careful as the acidic urine will draw in bicarbonate causing acidosis and hyperkalaemia so must have fully functioning kidneys
Continent cutaneous diversion (Indianna pouch) – pouch made from bowl which is then catheterised
How often are patients followed up post bladder cancer treatment?
Regular follow up with cystoscopy every 3 months for high risk and after 9 months and then yearly for low risk patients.
How common is testicular cancer?
Uncommon cancer but most common in men aged 15-44 (less common in older men).
What are the types of testicular cancer?
Majority are seminomas, non seminomatous germ cell tumours (NSGCT), mixed germ cell tumour and lymphoma.
What are the risk factors for testicular cancer?
Undescended testicle Infant hernia Infertility Family History Klinefelter’s syndrome Mumps orchitis
What are the signs and symptoms of testicular cancer?
Lump – solid mass inseparable from the testis on examination – cancer until proven otherwise. Often found after trauma or infection.
Can be painful
Symptoms from hormones released – gynaecomastia
Dyspnoea or swollen abdomen if advanced disease
Can present systemically if metastasised
What investigations should be done in suspected testicular cancer?
USS is the key diagnostic test
CT chest/abdo/pelvis for staging
Tumour markers
Alpha-fetoprotein specific to NSGCT
Beta-HCG – raised in NSGCT and 10% of seminomas
LDH – marker of tumour bulk
How is testicular cancer staged?
Staging
- No evidence of metastasis
- Infradiaphragmatic node involvement
- Supradiaphragmatic node involvement
- Lung involvement
