Bladder Cancer

Question 1

TCC and field defect

Answer 1

The urothelial lining covers basically the whole urogenital surface therefore the entire urothelium is prone to malignant change

Question 2

TCC etiology

Answer 2

Smoking
Industrial carcinogens eg aromatic amines: petroleum, rubber, chemical, printing, dye, leather.
Drugs: analgesic abuse, cyclophosphamide
Pelvic irradiation
Cyclamate

Question 3

TCC spread

Answer 3

Local: detrusor muscle➡️pelvic side wall, ureteric orrifices, prostate, uterus
Lymphatic: iliac➡️ para aortic
Haematogenous: lungs, liver, bone.

Question 4

TCC staging and grading

Answer 4

Stage : clinically with biannual rectal. Superficial tumor: at1. Muscle invasive tumor: T2. Palatable mass post TURBT and mobile T3 and the previous but fixed T4
Can also stage via CT.

Question 5

Ddx filling defect in bladder

Answer 5

Bladder ca. 
Blood clot 
Bladder stone 
Prostate
Foley catheter balloon 
Bowel glass
Foreign body 
Fungus ball

Question 6

Intravesicular BCG Bacille Calmette Guerin

Answer 6

For T1 and Tcis TCC
Immunotherapy
Weekly for 6 weeks then every 3 months for 3 years

Question 7

Squamous cell carcinoma etiology

Answer 7

Chronic irritation➡️ metaplasia of normal bladder epithelium➡️ scc
Bladder calculi
Recurrent UTI
Long term catheter. >10 years= 10% chance scc

Question 8

Adenocarcinoma ca. classification

Answer 8

Primary: urachal ca. , secondary to cystitis cystica, untreated bladder exstrophy
Secondary: prostate, sigmoid colon, rectum, uterus, stomach

Question 9

Types of cancer and rank most common

Answer 9

Transitional cell aka urothelial cell 94%
Squamous cell 5%
Adenocarinoma