Bladder Cancer

Question 1

What are risk factors for bladder cancer?

Answer 1

Smoking
Exposure to aniline ayes in printing and testile industry
Rubber manufacture
Cyclophosphamide
Chronic cystitis
Shictosomiasis infection

Question 2

What is histology of bladder cancer?

Answer 2

90% transitional cell carcinoma

Adenocarcinoma and SCC are rare in UK

Question 3

What is presentation of bladder cancer?

Answer 3

Painless frank macrosopcichaematuria
Recurrent UTI
Voiding irritability

Question 4

2WW referral criteria?

Answer 4

> 45 years with visible haematuria

Question 5

What investigation for bladder cancer?

Answer 5

Cystoscopy with biopsy
URine: microscopy/cytology - can cause sterile pyuria
CT urogram
Bimanual EUA
MRI

Question 6

Staging of bladder cancer?

Answer 6

CT CAP
Pelvic MRI for locoregional spread

Tis - in situ
Ta - confined to epithelium
T1 - submuscosa or lamina propria
T2 - muscle invasion
T3 - perivescial fat
T4 - Invades adjacent organs

N0 - no LN involved
N1-N3 - Progressive LN involvement

M0 - no mets
M1 - distant mets

Question 7

Mx of Tis/Ta/T1 tumours?

Answer 7

Diathermy via transurethral cystoscopy
or transurethral resection of bladder tyumour

Intravesical BCG which stimulates non-specific immune response

Question 8

Mx of T2/T3 tumours?

Answer 8

Radical cystectomy
Post-op chemotherapy
Neoadjuvant chemotherapy

Question 9

Mx of T4 tumours

Answer 9

Palliative chemo or radiotherapy

Chronic catheterisation and urinary diversions to relieve pain

Question 10

What follow up for high risk tumours? Low risk?

Answer 10

Every 3m for 2y then every 6m

Low risk:Yearly

Question 11

How do bladder tumours spread?

Answer 11

Local to pelvic structures
Lymphatic to iliac and para-aortic nodes
Haematogenous to liver and lungs

Question 12

What are complications of bladder cancer?

Answer 12

Cystectomy can result in sexual and urinary malfunction

Massive bladder haemorrhage

Question 13

What are clinical features of renal cell carcinoma?

Answer 13

Haematuria
Loin pain
Abdominal mass
Anorexia
Malaise
Weight loss

Question 14

What investigation in RCC?

Answer 14

BP - increased from renin secretion
Blood: 
FBX - polycythaemia from EPO secretion
ESR
U&E
ALP (bony mets)

Urine:
RBCs
cytology

Imaging:
US
CT/MRI
CXR - cannonball mets

Question 15

What Mx in RCC?

Answer 15

Radical nephrectomy
Cryotherapy and radiofrequency ablation in patients unfit or unwilling to undergo surgery
Anti-VEGF agents