Bladder Cancer Flashcards
What is bladder cancer?
Develops in the lining of the bladder and is the most common tumour of the urinary system. More common in men.
Most diagnosed are superical (Ta, T1, CIS) with a good prognosis.
What are the subtypes of bladder cancer?
Transitional cell carcinoma - most common
Squamous cell carcinoma
Adenocarcinoma and sarcoma - rare
What can baldder cancers further be classified into?
Non-muscle invasive bladder cancer - does not penetrate into deeper layers of the bladder wall.
Muscle-invasive baldder cancer - penetrates into the deeper layers of the bladder wall
Locally advanced or metastatic baldder cancer - beyond the baldder and distally
What are the four layers of the bladder wall?
Inner lining - transitional epithelium (urothelium)
Second - connective tissue - lamina propria
Third - muscular layer - muscularis propria
Forth (outer) - fatty connective tissues
What are the risk factors for baldder cancer?
Smoking and increasing age
Aromatic hydrocarbons (industrial dyes or rubbers) Schistosomiasis infecion (specfically SCC subtype) Previous radiation to pelvis
What are the clinical features of bladder cancer?
Painless haematuria - visible or non-visible
Recurrent UTIs or LUTS
Examination - unremarkable. Unless obstrcution of ureteric orifice
Localised symptoms - pelvic pain
Symtemic symptoms - weight loss or lethargy
What is the bladder cancer staging?
Ta - non-invasive papillary tumour
Tis - in situ
T1 - through lamina propria into sub-epithelial connective tissue
T2- into muscularis propria layer
T3 - invasion into the perivesical tissues
T4 - direct invasion into adjcent local structures
What are the differential diagnosis for bladder cancer?
UTI
Renal calculi
Prostate or renal cancer
What is the initial investigation for all patients suspected with bladder cancer?
Urgent flexible cystoscopy - under LA
What is done if suspicious lesion is identified on initial cystoscopy?
Rigid cystoscopy will be required for definitive assesement - under GA
Biposy wil be required and potential transurethral resection of the bladder tumour (TURBT) if appears superfical or await biposy result if appears invasive
What other investigations may be done in bladder cancer?
Imaging - CT staging - muscle invasion
Urine cytology - identify cancerous cells
What is done if cytology shows cancerous cells but cystoscopy shows normal epithelium?
Random biopsies at cystoscopy should be performed
What is the managment of of non-muscle invasive bladder cancer?
Carcinoma in-situ ot T1 tumours - resected bt TURBT
Higher risk may requires intrevesical BCG therapy
Radical cystectomy can also be offered for high risk or limited response to intial treatments.
What is the main risk of superficial bladder tumours and what is required becuase of this?
High rate of recurrence with around 70% in 3 years which are more likley to be invasive. Therfore pts require regular surveillance vis cytology and cystoscopy.
What is the management of muscle-invasive baldder cancers?
Those fit for surgery - radical cystectomy
Neoadjuvant chemotherapy
After radical cystectomy they reuire urine diversion:
- ileal conduit formation with urine drianing vis urostomy
- bladder reconstruction - from segment of small bowel and urine draining uretherally or via catheter
