Bladder cancer

Question 1

Bladder cancer is the most common subtype of t_____ cell carcinoma

Answer 1

transitional

Question 2

True or false: the majority of bladder cancers are superficial at presentation (do not invade the muscle)

Answer 2

True

Question 3

What is schistosomiasis?

Answer 3

Parasitic infection caused by flatworms, prevalent in tropical regions with limited access to clean water.
Intermediate stage in freshwater snails.
Contact with infested water, penetrate skin, worms grow in blood vessels around bladder (and other organs).
Commonly cause fever, fatigue, abdominal pain, diarrhoea and blood in urine or stool.

Question 4

If a patient has schistosomiasis, what kind of carcinoma in the bladder is more likely?

Answer 4

Squamous cell carcinoma (rather than transitional)

Question 5

Other than TCC and SCC what are rarer causes of bladder cancer?

Answer 5

Adenocarcinoma (glandular, malignant)

Sarcoma (begin in bones and soft tissue, malignant)

Small-cell carcinoma (undifferentiated neoplasm, is often malignant)

Question 6

What are risk factors for bladder cancer?

Answer 6

Smoking
Age
Occupational exposure to dyes / paints/ rubber (eg painter, hairdresser, mechanic)
Chemotherapy
Radiotherapy
Male

Question 7

Commonly a dye factory worker with painless haematuria has ______ cell carcinoma of the bladder

Answer 7

transitional

Question 8

Patients with asbestos exposure get…

Answer 8

mesothelioma

Question 9

Patients with outdoor work and significant sun exposure commonly get…

Answer 9

skin cancer

Question 10

What is a sign of bladder cancer?

Answer 10

Painless haematuria (can be macroscopic or microscopic)

Question 11

How do you diagnose bladder cancer?

Answer 11

Flexible cystoscopy and biopsy

Question 12

NICE guidlines on recognising cancer advises a t__ w___ w___ referral for aged over 45 with unexplained visible haematuria or aged over 60 with microscopic haematuria with dysuria or raised WBCs

Answer 12

two week wait

Question 13

NICE guidelines recommend considering a non-urgent referral in people over 60 with…

Answer 13

recurrent unexplained UTIs

Question 14

True or false: anaesthetic cannot be used for cystoscopy

Answer 14

False
Can be performed under local or general anaesthetic

Question 15

What staging system is used for bladder cancer?

Answer 15

TNM
(tumour, node, metastasis)

Question 16

Invasive bladder cancer includes what T stages?

Answer 16

T2-T4 and any lymph node or metastatic spread

Question 17

What treatment options are available for bladder cancer?

Answer 17

Conservative support from specialist nurse
Chemotherapy
Radiotherapy
Surgery - TURBT

Last resort = cystectomy

Question 18

What is TURBT?

Answer 18

transurethral resection of bladder tumour
Used for non-muscle-invasive bladder cancer

Question 19

What is intravesical chemotherapy?

Answer 19

Chemotherapy given into the bladder through a catheter.
Often used after TURBT to prevent recurrence.

Question 20

How does the BCG vaccine play a role in treatment of bladder cancer?

Answer 20

Can be used as form of immunotherapy. The vaccine commonly used for TB can be given into the bladder and is thought to stimulate the immune system to attack the bladder tumours.

Question 21

How is urine drained after radical cystectomy?

Answer 21

Urostomy with an ileal conduit (most common)

Continent urinary diversion
Neobladder reconstruction (using section of ileum)

Ureterosigmoidostomy