Bladder cancer

Question 1

What is the most common tumour of the urinary system?

Answer 1

Bladder

Question 2

What are the different types of bladder cancer and which is the most common?

Answer 2

Transitional cell carcinoma (most common)
Squamous cell carcinoma (SCC)
Adenocarcinoma (rare)
Sarcoma (rare)

Question 3

What are risk factors for bladder cancer?

Answer 3

Smoking 
Increasing age
Exposure to certain industrial dyes / rubbers - aromatic amines
Schistosomiasis infection
Previous radiation to the pelvis

Question 4

How does bladder cancer normally present?

Answer 4

Painless haematuria - either visible or non visible
Recurrent UTIs
LUTS such as frequency, urgency
Some signs of ureteric obstruction may be present (depending on position of the tumour)

If metastatic disease may have systemic symptoms

Question 5

How is bladder cancer diagnosed?

Answer 5

Cystoscopy - rigid or flexible

Biopsy (and resection - if superficial can be done at the same time) via TURBT (transurethral resection of bladder tumour)

Imaging - CT staging

Question 6

How is bladder cancer managed?

Answer 6

TURBT - transurethral resection of bladder tumour - for non muscle invasive
Intravesical chemotherapy
Intravesical BCG 
Radical cystectomy
May need neoadjuvant chemotherapy

Question 7

How is urine drained after a radical cystectomy?

Answer 7

Ileal conduit formation - urine drains via a urostomy

Bladder reconstruction using a segment of small bowel (neobladder)

Question 8

What are some complications of bladder cancer?

Answer 8

High recurrence rate
Higher risk of upper urinary tract and urethral tumours
Metastatic disease –> death