Bladder Cancer Flashcards
What is bladder cancer, and which type is most common?
Bladder cancer is a malignancy of the epithelial lining of the urinary bladder. The most common type is transitional cell carcinoma (TCC).
Who is most likely to be affected by bladder cancer, and how does the incidence change with age?
Bladder cancer is more prevalent in men than in women, and its incidence increases with age, with the majority of cases diagnosed in individuals over 55 years old.
What is the hallmark symptom of bladder cancer?
The hallmark symptom of bladder cancer is hematuria, which can be either gross (visible) or microscopic (detected on urine analysis).
What are other common symptoms of bladder cancer?
Other symptoms may include dysuria (painful urination), frequency (increased need to urinate), urgency (strong need to urinate), and lower abdominal pain (associated with more advanced disease).
Why is painless hematuria significant in bladder cancer diagnosis?
Painless hematuria, especially in early-stage disease, is a common presenting symptom of bladder cancer, making it crucial for early detection.
What other conditions can cause hematuria, and how does this relate to bladder cancer?
Hematuria can also result from urinary tract infections (UTIs), kidney stones, prostate disease, trauma, or bladder infections (cystitis). However, unexplained hematuria, particularly in at-risk populations, raises concern for bladder cancer.
What should be done when a patient presents with hematuria?
Any patient presenting with hematuria should be evaluated for bladder cancer, especially older individuals or those with risk factors, while also ruling out other differential diagnoses.
What are the key steps in the investigation of hematuria?
The key steps are:
- History and physical examination
- Urine dipstick and microscopy
- Urinary cytology
- Imaging studies (ultrasound, CT urography, MRI)
- Cystoscopy
- Biopsy (if a tumor is visualized)
What is involved in the history and physical examination for hematuria investigation?
The history includes assessing risk factors like smoking, occupational exposure, and chronic bladder infections. The physical examination involves palpation of the abdomen and pelvic area to detect signs of advanced disease, such as a palpable bladder mass.
What role do urine dipstick and microscopy play in investigating hematuria?
Urine dipstick tests for blood, followed by microscopic analysis to assess the number of red blood cells (RBCs) and detect abnormal cells. Microscopic hematuria (more than 3 RBCs per high-power field) is significant and requires further investigation.
What is urinary cytology, and when is it used in bladder cancer investigation?
Urinary cytology examines a urine sample for cancerous cells. It is particularly useful in detecting high-grade bladder cancer. However, it has high specificity but lower sensitivity, especially for low-grade tumors.
What imaging studies are used in the investigation of hematuria?
Ultrasound: Often the first modality to rule out causes like kidney stones or urinary tract obstruction.
CT Urography (CTU): Provides a detailed assessment of the urinary tract and can detect masses and urothelial abnormalities. It is more sensitive than ultrasound.
MRI: Used for staging in advanced cases, especially for assessing pelvic and extravesical spread.
What is cystoscopy, and why is it important in the investigation of hematuria?
Cystoscopy is the gold standard for diagnosing bladder cancer. It allows direct visualization of the bladder to detect tumors, inflammation, or other abnormalities. It is performed under local anesthesia and is essential for obtaining biopsy specimens for histopathological evaluation.
What is the role of biopsy in the investigation of bladder cancer?
If a tumor is visualized during cystoscopy, a biopsy is performed to confirm the diagnosis and determine the grade and stage of the tumor.
How is smoking related to bladder cancer?
Smoking is the most important risk factor for bladder cancer. Tobacco smoke contains carcinogens that are excreted in the urine, where they can damage the bladder lining and increase the risk of cancer.
What occupational exposures increase the risk of bladder cancer?
Exposure to industrial chemicals, particularly aromatic amines (e.g., from dyes and rubber manufacturing), is a known risk factor for bladder cancer.
How do chronic bladder infections contribute to bladder cancer risk?
Long-term bladder inflammation or chronic infections can increase the risk of bladder cancer by causing continuous damage to the bladder lining.
How does a history of previous cancers affect the risk of bladder cancer?
A history of other cancers, such as colorectal cancer or prostate cancer, can increase the likelihood of developing bladder cancer.
What is the connection between schistosomiasis and bladder cancer?
Schistosomiasis, a parasitic infection, is associated with an increased risk of squamous cell carcinoma of the bladder, particularly in endemic areas such as parts of Africa and the Middle East.
How do age and gender influence the risk of bladder cancer?
The risk of bladder cancer increases with age, and men are more commonly affected than women.
How does family history impact the risk of bladder cancer?
A family history of bladder cancer increases the likelihood of developing the disease, suggesting a genetic predisposition.
How is bladder cancer staged?
Bladder cancer is staged according to the TNM system:
T: Depth of invasion into the bladder wall.
N: Involvement of regional lymph nodes.
M: Presence of metastasis to distant organs.
What are the characteristics of Non-Muscle Invasive Bladder Cancer (NMIBC)?
NMIBC is confined to the mucosa or submucosa. It includes:
Ta: Non-invasive papillary carcinoma.
T1: Tumor invades the submucosa but not the muscle layer.
What are the stages of Muscle-Invasive Bladder Cancer (MIBC)?
MIBC involves deeper layers of the bladder wall:
T2: Tumor invades the muscle layer.
T3: Tumor extends through the bladder wall into surrounding tissues.
T4: Tumor invades nearby structures (e.g., prostate, uterus).
