Bladder Cancer

Question 1

Pathology of bladder ca. (3)

Answer 1

> 90% TCC
7% SCC and assoc. w. inflammation e.g. schistosomiasis, long term catheters
1% adenocarcinomas

Question 2

Risk factors (9)

Answer 2

Smoking
age 
analine dyes
aromatic amines e.g. rubber factories, hairdressers
hydrocarbons
male
drugs e.g. cyclophosphamide (also haem cystitis), phaenacetin
radiation
inflammation

Question 3

presentation of bladder ca. (5)

Answer 3

most have painless visible haematuria

other Sx include: bladder pain, dysuria, recurrent UTIs and urgency.

Question 4

Ix for bladder ca. (4)

Answer 4

first dip urine for haematuria
then usual haematuria Ix:
-USS+CT urogram
-cystoscopy+biopsy=diagnostic
-cytlogocy (some ca.>sterile pyuria)

Question 5

Management of low risk non-muscle invasive ca. (4)

Answer 5

TURBT (complications are infection, bladder perf, haematuria, urethral strictures).
patients also receive single-dose intravesicular chemo: mitomycin C, doxorubicin, cysplatin (lowers recurrence).
BCG can also be used
cytoscopic follow-up at 3mo, 9mo then yrly for 5 yrs.

Question 6

Mx of medium-risk non-muscle invasive ca.

Answer 6

6wk course of intravesicular chemo

Question 7

Mx of high-risk non-muscle invasive ca. (2)

Answer 7

6wk course of BCG (mediates immune response)

if this fails then radical cystectomy(+LNs)-complications are erectile dysfunction in 90%, hernia and infection

Question 8

Rx and Ix for muscle invasive ca. (6)

Answer 8

can have either:

• radical cystectomy with bladder reconstruction
• external beam radiotherapy
• selective resection w. neo-adjuvant chemo: gemcitabine+cisplatin

Ix:

• CT chest/abdo/pelvis
• bone scan
• MRI pelvis for LNs