Bladder cancer Flashcards
Types of bladder cancer
TCC 80%
SCC 20%
Causes of TCC
Smoking
Aromatic amine exposure
Causes of SCC
Long term catheter
Recurrent UTIs
Bladder stones
Schistosomiasis
What does TURBT allow assessment of
Histological type
Grade
Tis/Ta/T1
Describe TNM stages
Tis: epithelial, flat Ta: epithelial, projects into cavity T1: lamina propria T2: muscle invasive T3: fat around bladder T4: adjacent structures
Initial treatment for Tis, Ta and T1
Single dose intravesical mitomycin
Treatment for T2
Neoadjuvant chemo and cystectomy OR chemoradiotherapy if bladder confined
Palliative chemo if mets
Treatment of superficial bladder cancer
Low risk:
Surveillance
Intermediate risk:
6x weekly intravesical mitomycin to reduce recurrence
High risk:
BCG regimen or hyperthermic mitomycin to reduce progression
Describe low/intermediate/high risk superficial bladder cancer
Low: G1/2, Ta, solitary
Intermediate: G1/2, Ta, multiple, large
High: G3, T1, carcinoma in situ
Male vs female radical cystectomy
M: cystoprostatectomy and LN dissection
F: anterior exenteration (bladder, uterus, uterine tubes, ovaries, anterior vaginal wall) and LN dissection
Options for urinary diversion following radical cystectomy
Ileal conduit - connect ureters to small bowel and make spouted stoma, drains continuously
Neobladder - connect ureters to new bladder made from small bowel which is connected to urethra
Continent cutaneous diversion - connect ureters to small bowel and make catheterisable stoma
Complications with continent cutaneous diversion
Incontinence Perforation Stones Mucus Needs emptying every 3 hours at start Hyperchloraemic metabolic acidosis
CI continent cutaneous diversion
Renal and hepatic impairment
Unable to self catheterise
Inadequate small bowel
CI for neobladder
Prostatic urethral spread of cancer
