Bladder Cancer Flashcards
ESSENCE
Arises from endothelial lining (urothelium), majority are superficial and do not invade muscle at presentation
AETIOLOGY
Risk factors
- Main risk factors are smoking and increased age
- Aromatic amines
- Found in dye and rubber industries
- Schistosomiasis
- Causes squamous cell carcinoma of bladder
Histological classification
- Transitional cell carcinoma (90%)
- Squamous cell carcinoma (5%)
- Rarer causes such as adenocarcinoma, sarcoma nd small-cell carcinoma
CLINICAL FEATURES
Presentation
- Painless haematuria
- Dysuria
INVESTIGATIONS
First choice
- Cystoscopy - diagnosis
- Urinalysis - haematuria
Staging
- TNM staging system
- Non-muscle invasive bladder cancer (Tis, Ta, T1)
- Muscle invading bladder cancer (T2, T3, T4) and any lymph node or metastatic spread
MANAGEMENT
General principles
- MDT team
- Surgery
- Chemotherapy and radiotherapy may also be used
MANAGEMENT
Surgical options
- Transurethral resection of bladder tumour (TURBT)
- Non-muscle invasive cancer
- Intravesical chemotherapy
- Intravesical Bacillus Calmette-Guerin (BCG)
- Radical cystectomy
What is intravesical chemotherapy
Chemotherapy given into bladder through catheter
Often used after TURBT to reduce risk recurrence
Why is BCG used
Thought to stimulate immune system which attacks bladder tumours
Options for removing urine following radical cystectomy
- Urostomy with ileal conduit (most common)
- Continent urinary diversion
- Neobladder reconstruction
- Ureterogigmoidostomy
What is urostomy
Used to drain urine from kidneys, bypassing ureters, bladder and urethra
Creates ileal conduit (section of ileum removed and attached to ureters, with other end forming stoma on skin draining into urostomy bag)
What is continent urinary diversion
Creating pouch inside abdomen from section of ileum, with ureters connected
Thin tube connects pouch to stoma on skin, need to intermittently insert catherter into stoma to drain urine from pouch
What is neobladder reconstruction
Creating new bladder from sections of ileum, connected to both ureters and urethra and functions similar to normal bladder
What is ureterosigmoidostomy
- Attaching ureters directly to sigmoid colon, where urine collects
- Techniques are used to prevent urine reflux
- Patient can drain urine by relaxing anal sphincter same way they open bowel
- Is rarely done now, due to association with infection of kidney, electrolyte imbalances and secondary cancer
