Bladder Cancer Flashcards
What are 2 key risk factors for transitional cell carcinoma (TCC)?
1) Smoking
2) Aromatic amines
What is the most common clinical presentation of bladder cancer?
Painless haematuria
Which medication is a risk factor for TCC?
Cyclophosphamide
What are 2 key risk factors for squamous cell carcinoma of the bladder?
1) Schistosomiasis
2) Smoking
What infection is a risk factor for squamous cell carcinoma of the bladder?
Schistosomiasis
What are the 3 types of bladder cancer?
1) TCC (>90%)
2) Squamous cell carcinoma
3) Adenocarcinoma
Where does cancer of the bladder arise from?
Endothelial lining (urothelium)
Where were aromatic amines used?
In dye and rubber industries
When is a 2 week wait referral for suspected bladder cancer indicated?
≥45 y/o with unexplained visible haematuria
≥60 y/o with microscopic haematuria (not visible but positive on a urine dipstick PLUS:
a) dysuria or;
b) raised WCC
Clinical features of bladder cancer?
1) Painless haematuria
2) LUTS: dysuria, frequency, urgency
3) Suprapubic pain
4) Systemic e.g. weight loss, fatigue, anaemia
1st line investigation in suspected bladder cancer?
Cystoscopy (a camera through the urethra into the bladder).
The cystoscope can be rigid or flexible.
What staging system is used for bladder cancer?
TNM staging
What is there a clear distinction between when staging bladder cancer?
Non-muscle-invasive bladder cancer (not invading the muscle layer of the bladder)
Muscle-invasive bladder cancer (invading the muscle and beyond)
What does non-muscle-invasive bladder cancer include on the TNM staging system?
Tis/carcinoma in situ: cancer cells only affect the urothelium and are flat
Ta: cancer only affecting the urothelium and projecting into the bladder
T1: cancer invading the connective tissue layer beyond the urothelium, but not the muscle layer
What does invasive bladder cancer include on the TNM system?
Invasive bladder cancer includes T2 – 4 and any lymph node or metastatic spread.
Possible mx options for bladder cancer?
1) Transurethral resection of bladder tumour (TURBT)
2) Intravesical chemotherapy
3) Intravesical Bacillus Calmette-Guérin (BCG)
4) Radical cystectomy
5) Chemotherapy & radiotherapy
What does TURBT involve?
Removing the bladder tumour during a cystoscopy procedure.
What is intravesical chemo?
Chemotherapy that is given into the bladder through a catheter.
This is often used after a TURBT procedure to reduce the risk of recurrence.
What is intravesical BCG?
Intravesical BCG may be used as a form of immunotherapy.
Giving the BCG vaccine (same one as for TB) into the bladder is thought to stimulate the immune system, which in turn attacks the bladder tumours.
What is a radical cystectomy?
Removal of entire bladder
