Bladder Cancer Flashcards
define bladder cancer
malignancy of bladder cells
what is the main type of bladder cancer
transitional cell carcinoma (urothelial carcinoma)
-90% of bladder cancers
what is the rarer type of bladder cancer
squamous cell carcinoma
what can be the cause of a squamous cell carcinoma of the bladder
chronic inflammation (e.g. schistosomiasis)
aetiology of bladder cancer
unknown cause; attributable cause of smoking is 50%
risk factors
smoking, dye, occupational exposure to carcinogens, chronic UTIs, pelvic radiation, schistosomiasis
what chemicals specifically are risk factors
Dye stuffs (naphthylamines and benzidine) Cyclophosphamide treatment
epidemiology
2% of all cancers but 2nd most common cancer of urogenital tract
which group is bladder cancer more common among
males (2-3x more likely)
age peak of incidence; 50-70 years
presenting symptoms: is there haematuria or not:? is it painless? is it visible?
painless, macroscopic haematuria
other presenting symptoms
irritative/storage symptoms;
nocturia,
frequency,
urgency
recurrent UTIs
rare presenting symptom
ureteral obstruction
signs of bladder cancer
no signs,
bimanual examination may be performed as part of staging
appropriate investigations
first line investigation: urinalysis
cystoscopy, ultrasound, intravenous urography,
when may a CT/MRI be done
for staging
Treatment (non invasive, low risk)
transurethral resection of bladder tumour
treatment (non invasive, low risk)
transurethral resection of bladder tumour
treatment (non invasive, high risk)
transurethral resection of bladder tumour
treatment (invasive, organ contained (T2a or 2b)
radial or partial cystectomy with pelvic lymph node dissection
treatment (invasive, non-organ contained (T3a or 3b)
radial cystectomy with pelvic lymph node dissection
treatment (invasive, non-organ contained (T4a or 4b)
chemotherapy or radiotherapy
treatment of metastatic disease
MAIN: chemotherapy//
surgery or radiotherapy
prognosis
Most patients present with low-grade, non-muscle-invasive bladder cancer (NMIBC). These patients are at high risk for tumour recurrence but low risk for disease progression and death. High-grade NMIBC, especially if invasive into the lamina propria or associated with carcinoma in situ (CIS), is a risk for both recurrence and progression and is treated with cystectomy if intravesical therapy fails. Once muscle invasion occurs, overall survival is in the range of 50% even with cystectomy.
prognosis summary
most cases are low grade, non invasive and even though recurrence risk is high, chances of disease progression and death is low
