Bladder cancer

Question 1

What type of cancer affects the bladder usually?

Answer 1

90% transitional cell carcinoma
-if urothelium undergoes metaplasia due to prolonged irrigation/infection than squamous or adenocarcinoma can occur (schistosomiasis for SCC) (calculi for SCC)

secondary cancer from direct invasion of colon/rectum/uterine cancer

Question 2

What is the gender preponderance for bladder cancer? how common is transitional cell carcinoma?

Answer 2

M:F 4:1

common >50yrs

Question 3

What are the 7 different risk factors for TCC?

Answer 3

• aniline dyes
• rubber industry
• benzidine
• cyclophosphamide
• analgesics
• smoking
• up to 50% pt.s with renal pelvic Ca get this

Question 4

What symptoms does TCC cause? 6

Answer 4

painless haematuria - most common
cystitis with sterile pyuria
may look like prostatism
anaemia
infection (due to necrotic part tumour)
pain if invaded out bladder

Question 5

TCC pathology:

• where do these most commonly arise?
• how could it cause ureteric obstruction
• what type of cells are usually seen?

Answer 5

75% in trigone region

• if bilateral can cause ureteric obstruction
• 80% papillary, 20% non-papillary

Question 6

How are TCC’s graded?

Answer 6

• atypia of tumour cells are graded 1-3, invasion of underlying stroma and detrusor muscle
• malignancy ranges from low grade superficial to high grade and invasive

Question 7

How is carcinoma in-situ in the bladder treated?

Answer 7

this can occur in flat epithelium - treat with BCG

Question 8

How is bladder cancer diagnosed?

Answer 8

Upper tract Imaging
In patients over the age of 40 CT urography is the imaging mode of choice to evaluate upper tract disease.
In patients under the age of 40 it is more common to use intravenous urography (IVU) or ultrasound to investigate for upper tract disease.

Urine Cytology: May show malignant cells.

Cystoscopy: The gold-standard diagnostic modality in bladder cancer is cystoscopy. Following cystoscopy, diagnosis is based on biopsy of lesions and histological evaluation of tissue.

CT and MR imaging: Should be used to stage muscle invasive bladder cancer.

In men under 20 and women under 30, if the haematuria is present with bacteria, then TCC can be omitted as a possible differential diagnosis as long as the haematuria disappears with treatment.

Question 9

What is the management of bladder cancer?

Answer 9

staging and grading directs management