Bladder Cancer

Question 1

How does bladder cancer classically present?

Answer 1

Frank painless haematuria

Question 2

If a patient presents with frank painless haematuria, where is it most likely that the blood has arisen from?

Answer 2

Bladder

Ureters

Urethra

Question 3

Which type of epithelium lines the bladder?

Answer 3

Transitional cell epithelium

Question 4

Which characteristics of transitional epithelium makes it suitable for lining the urinary tract?

Answer 4

It is made of 3-7 layers which are joined by tight junctions preventing toxins passing into the body

It constantly renews

Question 5

What are the two most common type of bladder cancer?

Answer 5

Transitional cell carcinoma (95%)

Squamous cell carcinoma (5%)

(percentages for western counries only)

Question 6

Why may squamous cell carcinoma of the bladder be more common in developing countries?

Answer 6

Schistosomiasis can cause SCC

Question 7

In the developing world what is the development of SCC in the bladder often due to?

Answer 7

Long term catheterisation

Recurrent UTIs

Longstanding kidney stones

(this causes chronic irritation, the same as schistosomiasis)

Question 8

What are the main risk factors for developing transitional cell carcinoma?

Answer 8

“Having trouble with your Pee SAC?”

P - Phenacetin (banned analgesic for link to urinary cancers)

S - Smoking

A - Aniline (and Benzidine) - Inorganic compounds in dye and rubber manufacturing

C - Cyclophsophamide

Question 9

Where does bladder cancer typically metastasize to?

Answer 9

Local lymph nodes

Lungs

Question 10

What are the two main types of transitional cell carcinoma in the bladder?

Answer 10

Papillary type

Nonpapillary type

Question 11

Most transitional cell carcinomas of the bladder are ___________ type

Answer 11

Most transitional cell carcinomas of the bladder are papillary type

(they grow like bushes)

Question 12

Which type of transitional cell carcinoma of the bladder is the most dangerous?

Answer 12

Non-papillary type

All are considered malignant

(arise from p53 mutations and grow flat and invasively)

Question 13

How can bladder cancer be diagnosed?

Answer 13

Cytoscopy and biopsy

Question 14

Transition (urothelial) cell carcinoma most typically occur in which age range?

Answer 14

Elderly

Question 15

What are the main issues with treatment of urothelial cell carcinomas?

Answer 15

Multifocal

Can recur

Question 16

How is bladder cancer generally treated?

Answer 16

Resection with cytoscope - Transurethral Resection of Bladder Tumour (TURBT)

Intravesical chemotherapy - Localised chemotherapy delivered to the bladder via catheter

Severe cases may require cystectomy

Question 17

In which instances are primary adenocarcinomas of the bladder most commonly found?

Answer 17

Bladder exstrophy (protrusion of baldder through birth defect)

Schistosomiasis

Question 18

In which type of bladder cancer will there be mucus in the urine?

Answer 18

Primary adenocarcinoma

(tumours of glandular tissue)