Bladder cancer

Question 1

What is the aetiology bladder cancer? (x4)

Answer 1

• Most important: smoking
• Occupational exposure to carcinogens such as aromatic amines (rubber, dyes) and aromatic hydrocarbons (aluminium, coal, roofing industries)
• Arsenic exposure in drinking water
• Radiation exposure

Question 2

What are the risk factors of bladder cancer? (x5)

Answer 2

T2 DM, chronic inflammation, Schistosoma infection, chronic indwelling catheters, family history

Question 3

What are the three main types of bladder cancer?

Answer 3

• UROTHELIAL CARCINOMA aka transitional cell carcinoma
• Squamous cell carcinoma
• Adenocarcinoma (glandular cells)

Question 4

How can bladder cancers be categorised based on invasiveness? (x3)

Answer 4

• NON-INVASIVE: includes papillary carcinoma and carcinoma in situ (CIS). Papillary carcinomas are found in a small section of tissue and can be easily removed; CIS is found only on/near bladder surface
• NON-MUSCLE-INVASIVE: has grown only into the lamina propria and not into muscle.
• MUSCLE-INVASIVE: invaded bladder’s wall muscle and sometimes into the surrounding fascia

Question 5

What is the pathophysiology of bladder cancer? (x2 points)

Answer 5

Carcinogens are concentrated and excreted in the urine. Exposure is prolonged in the bladder, hence appearance of urothelial carcinomas here. Bladder cancer is typically multifocal and synchronous (appearing at same time)

Question 6

What is the epidemiology of bladder cancer: Age? Where? Gender?

Answer 6

Occurs in people aged over 55. West has higher rates. More prevalent in males but females experience higher mortality.

Question 7

What are the signs and symptoms of bladder cancer? (x2)

Answer 7

• Haematuria (gross or microscopic)
• Dysuria
• Asymptomatic

Question 8

What are the investigations for bladder cancer? (x5)

Answer 8

• URINALYSIS: haematuria. Pyuria may also be seen, resulting in confusion with UTI
• URINE CYTOLOGY: positive in patients with high-grade tumours, 33% positive with low-grade tumours
• CYSTOSCOPY: endoscopy of the bladder to visualise tumours. Enables pathological diagnosis
• BLADDER USS: may be able to see tumour causing obstruction
• CT UROGRAM: visualised urinary tract

Question 9

How do investigations identify high- and low-grade bladder tumours?

Answer 9

Low-grade tumours are papillary and easy to visualise, but often have negative cytology. High-grade tumours are often flat or in situ and difficult to visualise, but typically have a positive cytology.