Bladder cancer

Question 1

What type of cancer presents in the bladder?

Answer 1

90% of bladder cancers are transitional cell carcinomas.

Question 2

How does bladder cancer present?

Answer 2

Painless haematuria
Recurrent UTI
Voiding irritability
Unintentional weight loss
Bone pain, pelvic pain, swelling of the legs (advance stages)

Question 3

What are the risk factors/associations for bladder cancer?

Answer 3

Smoking
Aromtic amine (rubber industry)
Chronic cystitis
Schistosomiasis (increased risk of squamous cell carcinoma)
Pelvic irradiation
Previous surgery e.g.  BPH
Type II diabetes
Long-term catheter
Chronic UTI’s
Chronic bladder stones
Early menopause (prior to the age of 42)

Question 4

How is bladder cancer investigated?

Answer 4

Cystoscopy with biopsy (diagnostic)
Urine: microscopy/cytology
CT urogram (staging/diagnoses)
Bimanual examination (under anesthetic)
MRI /lymphangiography (pelvic nodes)

Question 5

How is bladder cancer treated?

Answer 5

Tis/Ta/T1 staging (80% of patients):

• -> Diathermy via transurethral cystoscopy/transurthral resection of bladder tumour (TURBT)
• -> Consider intravesical chemotherapeutic agents for multiple small tumours or high-grade tumours (Mitomycin, Doxorubicin, cisplatin)
• -> Intravesical BCG (stimulated non-specific immune response)

T2-3:

• -> Radical cystectomy
• -> Radiotherapy: gives worse 5 year survival rate, but preserves the bladder
• -> post-op chemotherapy (methotrexate, vinblastine)

T4:
–> usually palliative chemo/radiotherapy. chronic catheterisation and urinary diversions may help to relieve pain.

Question 6

How does bladder cancer usually spread?

Answer 6

Local –> pelvic structures
Lymphatic –> iliac and para-aortic nodes
Haematogenous –> liver/lung

Question 7

What are the complications of bladder treatment?

Answer 7

Cystectomy can result in sexual and urinary malfunction.

Massive bladder haemorrhage may complicate treatment or be a feature of disease.

Question 8

How is bladder cancer staged?

Answer 8

Tis: carcinoma in situ
Ta: Tumour confined to epithelium
T1: Tumour in lamina propria
T2: Superficial muscle involved
T3: Deep muscle invovled
T4: Invasion beyond bladder