Bladder Cancer Flashcards
What are the causes of haematuria?
o Bladder cancer - classically painless o Renal cancer o UTI o Stones o Prostate disease o Nephrological disease
What investigations are carried out for haematuria for over >45s and <45s?
Haematuria + over 45y/o end up having a cystoscopy and upper tract scan (except female pt with simple UTI)
under 45 with microscopic haematuria do not need urological investigation - Check GFR, BP, urine protein excretion
How does bladder cancer present?
Painless, frank haematuria; recurrent UTIs; voiding irritability.
What investigations would be suitable for >45 y/o male patient presenting with painless haematuria?
2 WEEK CANCER REFERRAL
MSU (to rule out infection), U+E (to investigate renal disease), a flexible cystoscopy (to rule out bladder tumour) and a CT urogram (to exclude renal and ureteric tumours and stone disease) as well as a serum PSA to rule out prostate cancer.
What does urine dipstick show?
blood, protein (renal disorder), nitrites + leucocytes (infection), pH
What is urine microscopy, culture/sensitivity and cytology show?
RBCs, infection, cancer cells respectively
What is the main risk factor for bladder cancer?
increasing age, smoking and exposure to some industrial chemicals (such as those used in the dye industry and rubber manufacture)
What is the grading used for bladder cancer?
Grade 1 - least aggressive/well differentiated histologically
Grade 2 - intermediate
Grade 3 - most agressive/ least well differentiated histologically
What investigations are used in bladder cancer?
1) cystoscopy with biopsy
2) Urine - microscopy/cytology
3) CT urogram –> staging
4) bimanual EUA –> spread
How is bladder cancer staged?
pTa - cells confined to epithelium Tis - aggressive cells confined to epithelium T1 - submucosa/lamina propria T2 - invades muscle T3 - invades perivesical fat T4 - adjacent organs
N - node involvement
M - metastasis
What is treatment for Tis/Ta/T1?
Diathermy via transurethral cystoscopy/trans-
urethral resection of bladder tumour (TURBT).
Consider a regimen of intravesical BCG (which stimulates a non-specific immune response) for multiple small tumours or high-grade tumours.
Alternative chemotherapeutic agents include mitomycin, epirubicin and gemcitabine.
What is the treatment for T2-T3? (3)
Radical cystectomy is the ‘gold standard’.
Radical external beam radiotherapy - gives worse 5yr survival rates than surgery, but preserves the bladder. ‘Salvage’ cystectomy can be performed if radiotherapy fails, but yields worse results than primary surgery.
Post-op chemotherapy (eg M-VAC: methotrexate, vinblastine, doxorubicin, and cisplatin) is toxic but effective. Neoadjuvant chemotherapy with M-VAC or GC (gemcitabine and cisplatin) has improved survival compared to cystectomy or radiotherapy alone.
What is the treatment for T4 cancer?
Usually palliative chemo/radiotherapy. Chronic catheterization and urinary diversions may help to relieve pain.
What does follow-up consist of?
History, examination, and regular cystoscopy:
- High-risk tumours: Every 3 months for 2yrs, then every 6 months.
- Low-risk tumours: First follow-up cystoscopy after 9 months, then yearly.
