bladder cancer Flashcards
incidence
18,000 new cases each year in uk
4th commonest cancer in men (after Prostate, Lung and Colorectal)
Aetiology + Risk factors (6)
- Smoking esp black tobacco
- Occupational exposures - drivers bc diesel + oils + dyes + aspestos
- Pollution -
Iatrogenic - radiotherapy to pelvis - Infection/inflammation - schistomiasis fungi + bladder stone and chronic catherter
- Genetic risks - slow/absent GSTM1
- Microbiome
demographics
- north america + europe
- spain and greece bc high smoking
Pathology – Histological subtypes main 3
- Urothelial/Transitional cell carcinoma – 90%
- Squamous cell carcinoma – 5%
- Adenocarcinoma – 3%
Rare:
- Small cell carcinoma
- Sarcoma
- Melanoma
grading
2004 – ISUP
Low grade 50%
High grade 20% non-muscle invasive 30% muscle invasive
staging system
TNM system
symtpoms
- Haematuria - blood in urine
- bladder symtpoms such as urgency, painful, frequent
- often get diagnosed as uti first
Investigation
- History - eg smoker
- Urine tests for microscopy and culture
- Blood test
- ultrasound
- Endoscopy - flexible cystoscopy
treatment - muscle invasive vs non-invasive
CIS, Ta, T1 - non-invasive
- Endoscopic resection (TURBT)
± intravesical chemotherapy
± intravesical BCG (immunotherapy)
intravesical means putting the therapy directly into the bladder
T2, T3, T4 - invasive
Local:
- Cystectomy
- Radical radiotherapy
Systemic:
- Chemotherapy
- immunotherapy
Reconstruction after Cystectomy
- ileal conduit - stoma - majority
- continent cutaneous resevoir - stoma with small bowel
- orthotopic neobladder - new bladder made using pelvis
systemic chemo drug main
cisplatin
cis-platin
systemic treatments
- chemotherapy
- immunotherapy
- vaccines
- antibody drug conjugate
epidemiology
- inc with age
- average age of dignosis = 73
Bladder Cancer: Most common sites of metastasis?
lymph
bones
lung
liver
