Bladder Cancer

Question 1

Bladder cancer

Answer 1

Cancer in bladder arising from endothelial lining (urothelium).
Majority are superficial (not invading muscle) at presentation.

Question 2

Risk factors for bladder cancer

Answer 2

• smoking
• increasing age
• aromatic amines (in dye, rubbber)
• schistosomiasis (-> squamous cell)

Question 3

Stereotypical presentations relating to patients occupation (x3)

Answer 3

Dye factory worker:
- transitional cell carcinoma of bladder

Asbestos exposure:
- mesothelioma

Outdoor workers:
- skin cancers

Question 4

Types of bladder cancer

Answer 4

• transitional cell carcinoma (90%)
• squamous cell carcinoma (5% - schistosomiasis)
• adenocarcinoma (2%)

Question 5

Clinical features of bladder cancer

Answer 5

• painless haematuria
• other LUTS
• suprapubic pain

Question 6

Referral criteria for suspected bladder cancer

Answer 6

2 week urgent pathway:
- > 45yrs with unexplained visible haematuria (without UTI or persisting post-UTI treatment)
- > 60yrs with microscopic haematuria PLUS dysuria or raised WCC

Non-urgent:
- > 65yrs with recurrent, unexplained UTIs

Question 7

Diagnosing bladder cancer

Answer 7

Cystoscopy
- bladder through urethra into bladder

Question 8

Staging bladder cancer

Answer 8

Distinctions:
- non-muscular-invasive
- muscular-invasive

TNM:
- non-muscular-invasive (in situ, Ta, T1)
- muscular-invasive (T2-T4, any N, any M)

Question 9

Treatment options for bladder cancer

Answer 9

1. transurethral resection of bladder tumour (TURBT)(NMIBC)
2. intravesical chemotherapy (via catheter into bladder)
3. intravesical cacillus calmette-geurin (BCG) (BCG vaccine into bladder, immune system attacks tumour)
4. radical cystectomy (-> urostomy etc.)
5. chemotherapy and radiotherapy

Question 10

Urostomy

Answer 10

• drains urine from kidney, bypassing ureters, bladder and urethra
• most common solution post-cystectomy