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#Phase 2.1: Peri Op > Bladder Cancer > Flashcards

Bladder Cancer Flashcards

1
Q

Where does bladder cancer develop from?

A

Lining of bladder

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2
Q

What are the subtypes of bladder cancer? (3 things)

A
  1. TCC (transitional cell carcinoma) (90%)
  2. SCC (7%)
  3. Adenocarcinoma (3%)
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3
Q

What are the invasion types of bladder cancer? (3 things)

A
  1. Non-muscle-invasive bladder cancer (80%)
  2. Muscle-invasive bladder cancer
  3. Locally advanced / metastatic bladder cancer
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4
Q

What is Non-muscle-invasive bladder cancer?

A

Doesn’t penetrate into deep layer of bladder wall

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5
Q

What is Muscle-invasive bladder cancer?

A

Penetrates into deeper layers of bladder wall

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6
Q

What is Locally advanced / metastatic bladder cancer?

A

Spreads beyond bladder distally

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7
Q

What are the layers of the bladder wall? (4 things)

A 
INNER
1. Transitional epithelium (urothelium)
2. Lamina propria (CT)
3. Muscularis propria (muscular layer)
4. Fatty CT
OUTER
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8
Q

What are the risk factors for bladder cancer? (6 things)

A
  1. Smoking
  2. Age
  3. Male
  4. Aromatic amines exposure (rubber industry)
  5. Pelvic irradiation
  6. Schistosomiasis (for SCC subtype)
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9
Q

What are the clinical features of bladder cancer? (3 things)

A
  1. Painless haematuria (most common)
  2. Recurrent UTIs
  3. LUT symptoms (frequency / urgency)
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10
Q

What are some differentials that present similarly (haematuria) to bladder cancer? (3 things)

A
  1. UTI
  2. Renal calculi
  3. Prostate / renal cancer
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11
Q

What lab tests should be done for sus bladder cancer?

A

FBC

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12
Q

What would be seen in a FBC result of bladder cancer? (2 things)

A
  1. Leukocytosis (raised WCC)

2. Anaemia

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13
Q

How should all patients with sus bladder cancer be investigated initially?

A

Cytoscopy (FLEXIBLE cytoscopy under LOCAL)

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14
Q

If a sus lesion is found @ initial cytoscopy of bladder cancer what should the next investigation be?

A

RIGID cytoscopy under GENERAL (for definitive assessment)

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15
Q

If a tumour is found in the rigid cytoscopy of bladder cancer what should the next investigation be?

A

Biopsy + resection (via TURBT)

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16
Q

What imaging should be done for sus Muscle-invasive bladder cancer?

A

CT staging

17
Q

What investigation should be done to assess the SPREAD of bladder cancer?

A

Bimanual EUA (pelvic exam under anaesthetic)

18
Q

What imaging should be used to see pelvic nodes in bladder cancer

19
Q

What is the staging system for bladder cancer?

20
Q

What is the TNM staging for bladder cancer?

A 
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
21
Q

What is the management for EARLY (Tis / Ta / T1) Non-muscle-invasive bladder cancer?

A

TURBT resection (transurethral resection of bladder tumour)

22
Q

What is the management for HIGHER RISK (T2+) Non-muscle-invasive bladder cancer?

A

Adjuvant intravesical therapy

23
Q

What is TURBT resection (transurethral resection of bladder tumour)?

A

Bladder resection with diathermy during rigid cytoscopy

24
Q

What anaesthetic is TURBT done under?

A

GENERAL / REGIONAL

25
Q

What is the management for Muscle-invasive bladder cancer?

A

Radial cystectomy (complete removal of bladder)

26
Q

What is done in addition to the Radial cystectomy management of Muscle-invasive bladder cancer?

A

Neoadjuvant chemo (cisplatin combination regiment)

27
Q

What is needed after Radial cystectomy?

A

Urinary diversion

28
Q

What are the methods of urinary diversion? (2 things)

A
  1. Ileal conduit formation

2. Bladder reconstruction

29
Q

How does urine drain in Ileal conduit formation?

A

Via urostomy

30
Q

How does urine drain in Bladder reconstruction?

A

Urethrally / via catheter

31
Q

What is Bladder reconstruction made from?

A

Segment from small bowel

32
Q

What is the management of Local Advanced / metastatic bladder cancer? (2 things)

A
  1. Chemo (cisplatin / carboplatin + gemcitabine based regimen)
  2. Palliative (when appropriate)
33
Q

How does bladder cancer spread? (3 things)

A
  1. Locally –> pelvic structures
  2. Lymphatically –> iliac + paraortic nodes
  3. Haematogenously –> liver + lungs
34
Q

What are the complications of bladder cancer? (2 things)

A
  1. Cystectomy complication = sexual + urinary malfunction

2. Massive bladder haemorrhage

#Phase 2.1: Peri Op (24 decks)

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