Bladder cancer

Question 1

what are the types and which is most predominant in UK

Answer 1

transitional cell carcinoma (>90% in UK), squamous cell (assoc with schistosomiasis), adenocarcinoma

Question 2

what are the 3 grades and which is differentiated

Answer 2

grade 1-3, grade 1 is differentiates, grade 3 poorly differentiated

Question 3

what % are confined to bladder mucosa

Answer 3

80%. only 20% penetrates muscle

Question 4

what is the presentation

Answer 4

painless haematuria, recurrent UTIs, voiding irritability

Question 5

associations

Answer 5

smoking, aromatic amines (rubber industry), analine dyes, chronic cystitis, schistosomiasis, pelvic irradiation

Question 6

what tests can be done

Answer 6

cystoscopy with biopsy diagnostic; urine- microscopy and culture (cancer- may have sterile pyuria); UT urogram; bimanual EUA, MRI or lymphangiography

Question 7

what is the staging

Answer 7

Tis, Ta (epithelium), T1 (lamina propria), T2 (superficial muscles); T3 (deep muscle); T4 (invasion beyond bladder)

Question 8

treatment- Tis,a,1

Answer 8

diathermy via transurethral cystoscopy/transurethral resection of the bladder

Question 9

treatment T2-3

Answer 9

radical cystectomy. radiotherapy, post op chemo, neoadjuvant chemo

Question 10

treatment T4

Answer 10

palliative chemo/radio. chronic catheterisation

Question 11

what is the follow up of high and low risk tumours

Answer 11

high risk- every 3 months for 2 years, then every 6 months. low risk- first after 9 months, then yearly

Question 12

how and where does the tumour spread to

Answer 12

local- to pelvic structures. lymphatic- to iliac and para aortic nodes. haematogenous- liver and lungs

Question 13

complications

Answer 13

cystectomy can result in sexual and urinary malfunction. massive bladder haemorrhage