Bladder Cancer

Question 1

What is the histological subtype of bladder cancers?

Answer 1

• Transitional cell carcinoma - urothelial (accounts for 90%)
• Squamous cell and others.

Question 2

What are the risk factors for bladder cancer?

Answer 2

• Smoking
• Aniline dyes - excreted in urine,
• Rubber manufacture
• Cyclophosphamide
• Schistosomiasis (squamous cell),
• Pelvic radiation,
• Family history

Question 3

What are the signs and symptoms of bladder cancer?

Answer 3

• Painless haematuria,
• Recurrent UTIs
• Hydronephrosis
• Systemic symptoms such as unintential weight loss and night sweats
• Cancer may invade obturator nerve which can cause neuropathic pain to the medial thigh.

Question 4

What are the differential diagnosis for bladder cancer?

Answer 4

• UTIs
• Renal stones
• BPH
• Intersitital cystitis

Question 5

What are the investigations for bladder cancer?

Answer 5

• Urinalysis,
• CT urogram
• Flexible cystoscopy, biopsy and potentially TURBT
• Staging via CT CAP

Question 6

Who should get an urgent referral to urology?

Answer 6

• > 45 years old with Visible haematuria in absence of infection.
• Non-visible haematuria if >60 with dysuria or raised WCC.
• Do routine referral if >60 with a UTI

Question 7

What is the staging for bladder cancer?

Answer 7

TNM staging.
Non-muscle invasive is Tis, Ta and T1
Muscle invasion is T2-4

Question 8

What is the treatment of non-muscle invasive bladder cancer?

Answer 8

• Surgery: Transurethral resection of the bladder tumour (TURBT) - gold standard
• Chemotherapy: Bladder is instilled with mitomycin C (prevents recurrence)
• Immunotherapy: BCG immunotherapy if patients are at high risk (due to high grade) (prevents progression)

Question 9

What is the treatment for muscle invasive cancer?

Answer 9

Gold standard - Cystectomy with urinary diversion and neoadjuvant chemotherapy. (ileial conduit, neo-bladder, ureterosigmoidostomy)
Chemo and radiotherapy can be curative and palliative

Question 10

What is a urostomy?

Answer 10

Most common and popular solution after removal of bladder. Involves creating an ileal conduit, urine then drains into a urostomy bag.

Question 11

What is the treatment of metastatic bladder cancer?

Answer 11

Mets often in the lungs. It is treated with chemotherapy but often palliative (M-VAC chemo)

Question 12

What are the complications of bladder cancer?

Answer 12

Recurrence, hydronephrosis, urinary retention

Question 13

What is the prognosis for bladder cancer?

Answer 13

• Non muscle invasive bladder cancer has high risk of recurrence but low risk of progression
• Muscle invasive cancer has a 50% survival