Bladder Cancer

Question 1

Cancer in the bladder arises from?

Answer 1

urothelium

Question 2

Risk factors bladder cancer?

Answer 2

Smoking and increased age are the main risk factors for bladder cancer.

Aromatic amines are worth noting as a carcinogen that causes bladder cancer. Aromatic amines were used in dye and rubber industries but have been heavily regulated or banned for many years. They are also found in cigarette smoke and seem to be the reason smoking causes bladder cancer.

Schistosomiasis causes squamous cell carcinoma of the bladder in countries with a high prevalence of the infection.

Question 3

Types bladder cancer?

Answer 3

Transitional cell carcinoma (90%)
Squamous cell carcinoma (5% – higher in areas of schistosomiasis)
Rarer causes are adenocarcinoma (2%), sarcoma and small-cell carcinoma

Question 4

Presentation bladder cancer?

Answer 4

Painless haematuria is the symptom to remember for your exams.

The NICE guidelines on recognising cancer (last updated January 2021) advises a two week wait referral for:

Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI
Aged over 60 with microscopic haematuria (not visible but positive on a urine dipstick) PLUS:
Dysuria or;
Raised white blood cells on a full blood count

Question 5

Diagnosis bladder cancer?

Answer 5

Cystoscopy (a camera through the urethra into the bladder) can be used to visualise bladder cancers. The cystoscope can be rigid or flexible. Cystoscopy can be performed under local or general anaesthetic.

Question 6

Treatment bladder cancer?

Answer 6

Transurethral resection of bladder tumour (TURBT) may be used for non-muscle-invasive bladder cancer. The involves removing the bladder tumour during a cystoscopy procedure.

Intravesical chemotherapy (chemotherapy given into the bladder through a catheter) is often used after a TURBT procedure to reduce the risk of recurrence.

Intravesical Bacillus Calmette-Guérin (BCG) may be used as a form of immunotherapy. Giving the BCG vaccine (the same one as for tuberculosis) into the bladder is thought to stimulate the immune system, which in turn attacks the bladder tumours.

Radical cystectomy involves the removal of the entire bladder. Following removal of the bladder, there are several options for draining urine:

Urostomy with an ileal conduit (most common)
Continent urinary diversion
Neobladder reconstruction
Ureterosigmoidostomy

Chemotherapy and radiotherapy may also be used.