bladder ca Flashcards
def of bladder ca
malignancy of the bladder cells
aetiology of bladder ca
unknown
common genetic abnormalities = chr 9 deletions in superficial tumours, p53 mutations and 14q or 17q deletions in more invasive tumours
RF for bladder ca
strong association with smoking
exposure to carcinogens - benzidine in dye, aniline dyes, textiles, priniting, rubber and leather industries
clyclophosphamide treatment (10% risk after 12 years of exposure)
pelvic irradiation eg for cervical carcinoma
chronic UTIs - schistosomiasis (increase risk of squamous cell carcinoma)
pathology of bladder ca
majority are transitional cell carcinoma
rarely squamous cell associated with chronic inflammation eg in schistosomiasis, long term catheters or untreated stones
adenocarcinomas can arise in urachal remnant
mesenchymal tumours (leiomyosarcomas) rare
visible on cystoscopy - carcinoma in situ as an erythematous area, tumours as exophytic papillary fronds. Tends to be multifocal
epidemiology of bladder ca
approx 2% of all cancers
2nd most common cancer in the gentiurinary system
males 2-3x as commonly affected as women
50-70yrs
13000 new cases/yr, 5300 deaths/yr
sx of bladder ca
painless macroscopic haematuria
is the haematuria continuous, initial or terminal
urinary frequency, urgency, nocturia (irritative)
recurrent UTIs
rarely - pain due to clot retention - they can cause blockage = retention, ureteral obstruction or extension to pelvis
systemic symptoms - weight loss, fatigue
suprapubic pain or discomfort
signs of bladder ca
often none
under GA bimanual examination is a part of disease staging
Ix for bladder ca
cystoscopy - visualisation of the tumour, biopsy or removal
USS, IVU - assess upper and lower urinary tract - tumours can be multifocal
CT or MRI for staging
urine cytology and microscopy - cancers may cause sterile pyuria
no consistent tumour markers associated
MRI or lymphangiography may show involved pelvic nodes
CT urogram is both diagnostic and provides staging.
mx of non-muscle invasive tumours
transurethral resection of bladder tumour
+- intravesical chemo
+- immunotherapy
mx of locally invasive bladder tumours
- radical or partial cystecotmy with pelvic lymph node dissection
- if T4 - 1st line is chemo
consider
* preop chemo
* post op chemo/chemo-radiation
2nd line - immunotherapy
mx of metastatic bladder cancer
chemotherapy
consider surgery/radiotherapy
2nd line - immunotherapy
complications of bladder cancer
prostatic urothelial carcinoma
upper tract urothelial carcinoma
hydronephrosis
urinary retention
monitoring for bladder cancer
risk of recurrance needs lifelong monitoring - cystoscopy
high risk:
* every 3mo for 2yrs
* 6mo for 2-3yrs
* annually
low risk:
* 3 and 9 mo
* if normal - then annually
Px of bladder cancer
high risk of recurrance, low risk of death if low grade
if muscle invasion - survival = 50%
