Bladder cancer

Question 1

What is bladder cancer

Answer 1

Malignancy from urothelial cell lining of bladders inner surface

Question 2

Who gets bladder cancer

Answer 2

70+ years
Men 2.7:1 women

Question 3

Risk factors for transitional cell vs squamous carcoinpoma of bladder

Answer 3

Both smoking
Trnaslational - exposure to aniine dyes in printing and textile industry eg nezidine, 2-napthylamine
Rubber manufactire
Cyclophosphamide

SCC - schistosomiasis, smoking

Question 4

Types of bladder cancer

Answer 4

Trnasitional call carcinoma >90%
SCC 1-7% - schistosomiasis regions much higher
Adenocarcinoma 2%

Question 5

Presentation of bladder cancer

Answer 5

Haematuria most common presneting symptom - gross or microscopic, painless
Dysuria
Frequency
Urgency
Suprapubic pain
Sytemic - weight loss, fatigue, anaemia

Question 6

When refer someonw ith suspected bladder cancer

Answer 6

> 45 and have
-unexplained visible haematuria without UTI
-Visible haematuria persists or recurs after successful treatment of UTI infection or
60 and unexplained non visiubile haematuria and either dysuria or raised WCC
60 and recurrent or unexplained UTI consider

Question 7

INvestigaitons for bladder cancer

Answer 7

Cytoscopy and biospies - histological diagnosis and depth of incasion
Locoregional spread w MRI
Distant disease PETCT /CT (PET if nodes of uncertain significance) AA

Question 8

Treatment options for bladder cancer

Answer 8

Transurethral resection of bladder tumour - TUBRT - non muscle invasive bladder cancer
Remove during cytoscopy
Intravesical chemotherapy adjuvant to TURBT
Intravesical bacillus calmette-guerin - BCG - immunotherapy
Radical cystectomy - removing entired bladder -> Urostomy with an ileal conduit (most common)
Continent urinary diversion
Neobladder reconstruction
Ureterosigmoidostomy

Question 9

Options ofr non muscle invasive blader cancer

Answer 9

Transurethral resection of bladder tumour - TURBT
Intravesical therapy - IV BCG for high risk CIS
Maintneance therapy - BCG maintenance may be used

Question 10

Muscle invasive bladder cancer management

Answer 10

Neoadjuvatn chemo cisplatin before cystectomy
Radical cystectomy
Bladder sparing - combo of TURBT, chemo, raido
Adjuvant chemotherapy

Question 11

Metastatic baldder cancer options

Answer 11

First line - platinum based combo chemo ef MVAC or gemcitabine-cisplatin
Immune checkpoint inhibitorseg atezolimumab
Targeted therapy if specific molciular alterations present

Question 12

Prognsosi of bladder cancer 5 year survival

Answer 12

Generally good- present early
Oa/Ois- 69-98% survival
T1 lamina propria - 69-88%
T2 muscularis propia - 46%-63%
T3 perivesical tissue - 30-50%
T4 - adjacent organs/structures - 15-32%
Regional lymph node involvment 25-45%
Any stage M1 5%-15%