Bladder Cancer

Question 1

define bladder cancer

Answer 1

malignancy of bladder cells

Question 2

what is the main type of bladder cancer

Answer 2

transitional cell carcinoma (urothelial carcinoma)

-90% of bladder cancers

Question 3

what is the rarer type of bladder cancer

Answer 3

squamous cell carcinoma

Question 4

what can be the cause of a squamous cell carcinoma of the bladder

Answer 4

chronic inflammation (e.g. schistosomiasis)

Question 5

aetiology of bladder cancer

Answer 5

unknown cause; attributable cause of smoking is 50%

Question 6

risk factors

Answer 6

smoking, dye, occupational exposure to carcinogens, chronic UTIs, pelvic radiation, schistosomiasis

Question 7

what chemicals specifically are risk factors

Answer 7

Dye stuffs (naphthylamines and benzidine)  
Cyclophosphamide treatment

Question 8

epidemiology

Answer 8

2% of all cancers but 2nd most common cancer of urogenital tract

Question 9

which group is bladder cancer more common among

Answer 9

males (2-3x more likely)

age peak of incidence; 50-70 years

Question 10

presenting symptoms: is there haematuria or not:? is it painless? is it visible?

Answer 10

painless, macroscopic haematuria

Question 11

other presenting symptoms

Answer 11

irritative/storage symptoms;

nocturia,
frequency,
urgency

recurrent UTIs

Question 12

rare presenting symptom

Answer 12

ureteral obstruction

Question 13

signs of bladder cancer

Answer 13

no signs,

bimanual examination may be performed as part of staging

Question 14

appropriate investigations

Answer 14

first line investigation: urinalysis

cystoscopy, ultrasound, intravenous urography,

Question 15

when may a CT/MRI be done

Answer 15

for staging

Question 16

Treatment (non invasive, low risk)

Answer 16

transurethral resection of bladder tumour

Question 17

treatment (non invasive, low risk)

Answer 17

transurethral resection of bladder tumour

Question 18

treatment (non invasive, high risk)

Answer 18

transurethral resection of bladder tumour

Question 19

treatment (invasive, organ contained (T2a or 2b)

Answer 19

radial or partial cystectomy with pelvic lymph node dissection

Question 20

treatment (invasive, non-organ contained (T3a or 3b)

Answer 20

radial cystectomy with pelvic lymph node dissection

Question 21

treatment (invasive, non-organ contained (T4a or 4b)

Answer 21

chemotherapy or radiotherapy

Question 22

treatment of metastatic disease

Answer 22

MAIN: chemotherapy//

surgery or radiotherapy

Question 23

prognosis

Answer 23

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.

Question 24

prognosis summary

Answer 24

most cases are low grade, non invasive and even though recurrence risk is high, chances of disease progression and death is low