Bladder Cancer

Question 1

Define Bladder Cancer

Answer 1

Malignancy of the bladder

Question 2

What are the types of Bladder Cancer (+ most common)

Answer 2

90% of bladder cancers are urothelial carcinomas (known as transitional cell carcinoma)
Non-muscle-invasive tumours are the most common
Low-grade tumours are papillary
High-grade tumours are often flat or in situ and difficult to visualise

Question 3

Aetiology of Bladder Cancer

Answer 3

Carcinogens e.g. nitrosamines are concentrated and excreted in the urine where the urinary tract cells are exposed
‘Field effect’ = exposure of the urothelium to carcinogens at roughly the same concentration gives rise to an epithelium, from which occasional cells become initiated and give rise to independent clones of transformed cells.

Smoking is the most important causative factor (increases risk 2-4x)

Question 4

Risk Factors for Bladder Cancer

Answer 4

Smoking, tobacco exposure
Occupation exposure to chemical carcinogens e.g. Industrial dye exposure etc.
Arsenic exposure 
Age >55
Pelvic radiation 
Systemic chemotherapy 
Schistosoma infection
Male 
Chronic bladder inflammation
Family history 
T2DM

Question 5

Symptoms of Bladder Cancer

Answer 5

Gross haematuria
Dysuria
- Typical of carcinoma in situ OR high-grade urothelial carcinoma
- Associated with aggressive bladder cancer
- Rule out urinary infection
Urinary frequency

Question 6

Investigations for Bladder Cancer

Answer 6

Urinalysis: RBC casts and crenated red cells (glomerular bleeding)
Urine cytology: +ve (90% with in situ or high grade)
Bladder tumour antigen (BTA) raised

FBC: normal/mild anaemia
Raised alk phos

Renal and bladder USS: tumour seen
CT urogram: tumours, upper urinary tract tumours or obstruction
Cystoscopy + endoscopic resection: visualise bladder tumours
IV urogram: filling defect indicative of a bladder tumour
CT A+P/MRI: tumour or mets, no stones
Bone scan: if alk phos is elevated - ?mets