Bladder Cancer Flashcards
Where does cancer in the bladder arise from?
Urothelium (endothelial lining)
Majority are superficial, non-invasive
What are the risk factors of bladder cancer?
Aromatic amines-dye and rubber industry
Smoking
Schistosomiasis (squamous cell carcinoma)
How common are different types of bladder cancer?
Transitional cell carcinoma
90%
Squamous cell carcinoma
5% (higher in areas with schistosomiasis)
Adenocarcinoma
2%
Sarcoma and small-cell carcinoma
What is the key symptom of bladder cancer?
Painless haematuria
What does NICE recommend when managing patients presenting with bladder cancer?
Two week wait referral for:
- Over 45 with unexplained visible haematuria, without a UTI or persisting after treatment for a UTI
- Over 60 with microscopic haematuria and
- Dysuria or raised WBC on FBC
How is bladder cancer diagnosed?
Cystoscopy
What does non-muscle-invasive bladder cancer include?
Tis Carcinoma in situ, cancer cells only affect urothelium and are flat
Ta Cancer only affecting urothelium and projecting into bladder
T1 Cancer invading connective tissue layer beyond urothelium but not muscle layer
What does invasive bladder cancer include?
T2-4 and any lymph node or metastatic spread
What treatment options are available for bladder cancer?
Transurethral resection of bladder tumour
Non-muscle-invasive bladder cancer
Removing the bladder tumour
Intravesical chemotherapy
Chemotherapy given directly into bladder, often after TURBT
Intravesical Bacillus Calmette-Guérin
BCG vaccine into bladder stimulates immune system to attack bladder tumours
Radical cystectomy
Removal of entire bladder
After radical cystectomy, how is urine drained?
Urostomy with ileal conduit
Most common
Continent urinary diversion
Neobladder reconstruction
Ureterosigmoidostomy
What is a urostomy?
Used to drain urine by creating an ileal conduit
15-20cm of ileum is removed, bowel is reconnected
Ureters are anastomosed to section of ileum, other end of the ileum forms a stoma on the skin draining urine into a urostomy bag
What is a continent urinary diversion?
Pouch created inside the abdomen from section of ileum, ureters are connected
Pouch fills with urine
Thin tube connected between stoma on the skin and internal pouch
Catheter needs to be inserted into stoma to drain urine
What is a neobladder reconstruction?
New bladder created from section of ileum
Connected to both ureters and urethra
Functions similarly to normal bladder
May require catheterisation and bladder washouts to clear small bowel secretions
What is a ureterosigmoidostomy?
Ureters directly attached to sigmoid colon
Urine drains and collects in sigmoid
Rectum can be expanded to create a recto-sigmoid pouch (Mainz II procedure) for more space for urine to collect
Urine drained in same way bowels are opened
Why is ureterosigmoidostomy used rarely?
Associated with:
- Kidney infection
- Electrolyte imbalance
- Secondary cancer at anastomosis between ureters and sigmoid colon
