Bladder Cancer Flashcards
Where does bladder cancer develop from?
Lining of bladder
What are the subtypes of bladder cancer? (3 things)
- TCC (transitional cell carcinoma) (90%)
- SCC (7%)
- Adenocarcinoma (3%)
What are the invasion types of bladder cancer? (3 things)
- Non-muscle-invasive bladder cancer (80%)
- Muscle-invasive bladder cancer
- Locally advanced / metastatic bladder cancer
What is Non-muscle-invasive bladder cancer?
Doesn’t penetrate into deep layer of bladder wall
What is Muscle-invasive bladder cancer?
Penetrates into deeper layers of bladder wall
What is Locally advanced / metastatic bladder cancer?
Spreads beyond bladder distally
What are the layers of the bladder wall? (4 things)
INNER 1. Transitional epithelium (urothelium) 2. Lamina propria (CT) 3. Muscularis propria (muscular layer) 4. Fatty CT OUTER
What are the risk factors for bladder cancer? (6 things)
- Smoking
- Age
- Male
- Aromatic amines exposure (rubber industry)
- Pelvic irradiation
- Schistosomiasis (for SCC subtype)
What are the clinical features of bladder cancer? (3 things)
- Painless haematuria (most common)
- Recurrent UTIs
- LUT symptoms (frequency / urgency)
What are some differentials that present similarly (haematuria) to bladder cancer? (3 things)
- UTI
- Renal calculi
- Prostate / renal cancer
What lab tests should be done for sus bladder cancer?
FBC
What would be seen in a FBC result of bladder cancer? (2 things)
- Leukocytosis (raised WCC)
2. Anaemia
How should all patients with sus bladder cancer be investigated initially?
Cytoscopy (FLEXIBLE cytoscopy under LOCAL)
If a sus lesion is found @ initial cytoscopy of bladder cancer what should the next investigation be?
RIGID cytoscopy under GENERAL (for definitive assessment)
If a tumour is found in the rigid cytoscopy of bladder cancer what should the next investigation be?
Biopsy + resection (via TURBT)
What imaging should be done for sus Muscle-invasive bladder cancer?
CT staging
What investigation should be done to assess the SPREAD of bladder cancer?
Bimanual EUA (pelvic exam under anaesthetic)
What imaging should be used to see pelvic nodes in bladder cancer
MRI
What is the staging system for bladder cancer?
TNM
What is the TNM staging for bladder cancer?
Tis = in situ / within BM Ta = tumour confined to epithelium T1 = in submucosa / lamina propria T2 = in muscularis propria T3 = in perivesical fat T4 = invades adjacent organs
N0 = no LN involved N1 = 1 LN involved (under 2cm) N2 = 1 LN involved (2-5cm) / multiple LN (under 5cm) N3 = 1+ LN (5+ cm)
M0 = no metastases M1 = distant metastasis
What is the management for EARLY (Tis / Ta / T1) Non-muscle-invasive bladder cancer?
TURBT resection (transurethral resection of bladder tumour)
What is the management for HIGHER RISK (T2+) Non-muscle-invasive bladder cancer?
Adjuvant intravesical therapy
What is TURBT resection (transurethral resection of bladder tumour)?
Bladder resection with diathermy during rigid cytoscopy
What anaesthetic is TURBT done under?
GENERAL / REGIONAL
