Bladder cancer Flashcards
What is bladder cancer?
● Malignancy of bladder cells
What are the different types of bladder cancers?
- Urothelial cell carcinomas (a.k.a transitional cell carcinoma) >90%
- Squamous cell carcinoma 1-7%
- Adenocarcinoma (glandular cells) 2%
What causes squamous cell carcinoma, specifically when looking at bladder cancer
chronic bladder inflammation:
- urinary tract infection caused by:
1. “schistosoma haematobium” (a type of flatworm)
- more common in areas where schistosomiasis is endemic (middle east)
2. or long term catheterisation (>10yrs)
Explain the aetiology/risk factors of bladder cancer
- UNKNOWN
Risk Factors:
o Smoking
o Aromatic amines – rubber industry, dye stuffs (naphthylamines and benzidine)
o Chronic cystitis
- chronic UTIs
o Drugs (e.g. Cyclophosphamide)
o Pelvic radiation
o Schistosomiasis (parasitic worm infection)– inc risk of squamous cell carcinoma
Describe the epidemiology of bladder cancer
● 2% of cancers
● 2nd most common cancer of the genitourinary tract
● 2-3 x more common in MALES
● Peak incidence: 50-70 yrs
What symptoms of bladder cancer can be found during the history?
- Painless macroscopic haematuria
- Irritative/storage symptoms:
- Frequency
- Urgency
- Nocturia
- dysuria (pain or discomfort when you urinate)
- Voiding irritability - Recurrent UTIs
- Rarely: ureteral obstruction
- Suprapubic pain
- Lower urinary tract syndrome (patient voiding)
- Metastatic disease syndrome:
- Bone pain (bone mets)
- Haemoptysis (lung mets)
What signs of bladder cancer can be found on physical examinarions?
● Often NO SIGNS
● Bimanual examination may be performed as part of disease staging
What investigations are used to monitor bladder cancer?
- Cystoscopy (thin tube with light & camera) + Biopsy → Visualises bladder tumours and enable pathological diagnosis.
- Urinalysis → 1st line bedside. Haematuria.
- CT urogram- important to rule out upper tract disease before CT scan for staging- more sensitive than US
- Renal & Bladder ultrasound → staging (may also see hydronephrosis due to tumour causing obstruction)
- CT/MRI Abdomen & Pelvis → staging
- CXR → lung metastases
A patient >= 60 years of age with unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test should be referred using the suspected cancer pathway (within 2 weeks).
definitive diagnosis is made only by cellular morphology of the resected tumor
How are bladder cancer staged?
WHO TNM:
Tumour:
Ta. Papillary cancer that is confined to the mucosa of the bladder.
Carcinoma in situ. Cancerous cells have invaded the connective tissue beneath the mucosa, but have not yet reached muscle.
Muscle invasive
- T2 The tumour has locally invaded into the muscle of the bladder
- T3 The tumour has locally invaded into the perivesical fat, outside the muscular layer of the bladder.
- T4 The tumour has invaded to adjacent local structures. These may include the abdominal wall, bowel, rectum, seminal vesicles or vagina.
Lymph nodes:
NX: The regional lymph nodes cannot be evaluated.
N0 (N plus zero): The cancer has not spread to the regional lymph nodes.
N1: The cancer has spread to a single regional lymph node in the pelvis.
N2: The cancer has spread to more than 2 regional lymph node in the pelvis.
N3: The cancer has spread to the common iliac lymph nodes, which are located behind the major arteries in the pelvis, above the bladder.
Metastatic disease
M0: The disease has not metastasized.
M1: There is distant metastasis.
what are the treatment options for bladder cancers?
- Small tumours (T1)/ Non-muscle invasive & Low risk → Transurethral Resection of Bladder Tumour (TURBT- uses heat to cut out all visible bladder tumour through the camera)
- Larger / Muscle invasive tumours (T2 Disease) → radical cystectomy (removal of bladder, prostate and seminal vesicles)
- Metastatic Disease → palliative systemic chemotherapy
What complications may be associated with the management of bladder cancer?
Hydronephrosis, prostatic urothelial carcinoma.
Describe the prognosis of bladder cancer
High survival rate for non-invasive disease. 12% survival rate for metastatic disease.W
What is Schistosomiasis?
Schistosomiasis, also known as bilharzia, is an infection caused by a parasitic worm that lives in fresh water in subtropical and tropical regions
