Bladder Cancer

Question 1

What is bladder cancer?

Answer 1

Bladder cancer is the most common urinary tract tumour and a common cancer type in the UK, with a higher incidence in males.

Question 2

What is the most common type of bladder cancer?

Answer 2

Urothelial (transitional cell) carcinoma, accounting for approximately 90% of cases.

Question 3

What are common risk factors for bladder cancer?

Answer 3

Increasing age, smoking, male sex, occupational chemical exposure, pelvic radiation, cyclophosphamide use, chronic bladder inflammation, and schistosomiasis.

Question 4

What is the most common presenting symptom of bladder cancer?

Answer 4

Painless visible haematuria, occurring in 80-90% of cases.

Question 5

What are other possible symptoms of bladder cancer?

Answer 5

Non-visible haematuria, difficulty passing urine, changes in urinary frequency or urgency, recurrent urinary tract infections, pelvic pain, back pain, weight loss, and fatigue.

Question 6

At what age should patients with unexplained visible haematuria be referred for suspected bladder cancer?

Answer 6

Patients aged 45 and over with unexplained visible haematuria without urinary tract infection, or those with persistent or recurrent visible haematuria after successful treatment of a urinary tract infection.

Question 7

What are the primary methods for diagnosing bladder cancer?

Answer 7

Urinalysis, urine cytology, flexible cystoscopy, and imaging studies such as CT or MRI.

Question 8

What is the role of cystoscopy in bladder cancer diagnosis?

Answer 8

Flexible cystoscopy allows direct visualisation of the bladder mucosa to identify tumours and is essential for diagnosis.

Question 9

What is the purpose of transurethral resection of bladder tumour (TURBT)?

Answer 9

TURBT removes bladder tumours for both diagnostic (histological assessment) and therapeutic purposes.

Question 10

What are the treatment options for non-muscle-invasive bladder cancer?

Answer 10

Intravesical therapies such as Bacillus Calmette-Guérin (BCG) immunotherapy or intravesical chemotherapy, along with regular surveillance cystoscopies.

Question 11

What is the standard treatment for muscle-invasive bladder cancer?

Answer 11

Radical cystectomy with urinary diversion, often preceded by neoadjuvant chemotherapy.

Question 12

What are potential complications of bladder cancer?

Answer 12

Ongoing urinary symptoms, loin pain, hydronephrosis, intractable haematuria, pelvic pain, and metastasis.

Question 13

What is the 5-year survival rate for superficial bladder tumours?

Answer 13

Approximately 80-90%, though there is a high recurrence rate.

Question 14

What is the 5-year survival rate for muscle-invasive bladder cancer?

Answer 14

Approximately 30-60%.

Question 15

What is the 5-year survival rate for metastatic bladder cancer?

Answer 15

Approximately 10-15%.

Question 16

How does smoking influence bladder cancer risk?

Answer 16

Smoking significantly increases the risk of developing bladder cancer.

Question 17

What occupational exposures are linked to increased bladder cancer risk?

Answer 17

Exposure to paints, rubber production, dyes, and certain chemicals in industries like textiles and leather tanning.

Question 18

What is the significance of painless visible haematuria in adults?

Answer 18

It is a red flag symptom that warrants investigation for possible bladder cancer.

Question 19

What imaging modality is preferred for evaluating the upper urinary tract in suspected bladder cancer?

Answer 19

CT urogram is preferred to assess the upper urinary tract for any concurrent pathology.

Question 20

What is the role of urine cytology in bladder cancer evaluation?

Answer 20

Urine cytology can detect malignant cells shed into the urine, aiding in diagnosis, especially for high-grade tumours.

Question 21

What is Bacillus Calmette-Guérin (BCG) therapy?

Answer 21

BCG is an intravesical immunotherapy used to treat and prevent recurrence of non-muscle-invasive bladder cancer.

Question 22

What are common side effects of intravesical BCG therapy?

Answer 22

Dysuria, frequency, haematuria, and systemic symptoms like fever and malaise.

Question 23

What is a radical cystectomy?

Answer 23

Surgical removal of the entire bladder, typically performed for muscle-invasive bladder cancer.

Question 24

What are the options for urinary diversion after radical cystectomy?

Answer 24

Ileal conduit, continent urinary reservoir, or orthotopic neobladder.

Question 25

Why is regular surveillance important after bladder cancer treatment?

Answer 25

To monitor for recurrence, as bladder cancer has a high rate of recurrence, necessitating ongoing follow-up.