Bladder cancer

Question 1

What age is affected most?

Answer 1

50-80yrs

Question 2

What is the most common histological form?

Answer 2

transitional cell carcinoma

Question 3

What is the second most common histological form?

Answer 3

squamous cell carcinoma

Question 4

What is the third most common histological form?

Answer 4

adenocarcinoma

Question 5

What are the two main types of benign bladder tumour

Answer 5

• inverted urothelial papilloma

- nephrogenic adenoma

Question 6

What are the RFs for TCC?

Answer 6

• Smoking
• exposure to aniline dyes in printing and textile industry
• rubber manufacture
• cyclophosphamide

Question 7

What are the RFs for SCC?

Answer 7

• Schistosomiasis - fresh water in subtropical + tropical regions
• BCG
• Smoking

Question 8

How does bladder cancer present?

Answer 8

painless visible (macroscopic) haematuria
Recurrent UTIs
Voiding irritability (sx suggestive of UTI in absence of bacteruria)

Question 9

What investigations would u do?

Answer 9

1. Urine microscopy + cytology (ca may cause sterile pyuria) also dipstick to exclude UTI
2. Flexible cystoscopy w biopsy (TURBT)
3. CT urogram - diagnostic + provides staging
4. Pelvic MRI - determine spread

Question 10

Explain TNM staging of bladder cancer

Answer 10

Tis - carcinoma in situ
Ta - tumour confined to epithelium
T1 - tumour in subepithelial connective tissue (lamina propria)
T2 - invades muscle (muscularis propria)
T3 - extends to perivesical fat 
T4 - invades adjacent organs 
N0 - no LN
N1 - single regional LN metastasis in true pelvis
N2 - multiple LN metastasis 
N3 - LN metastases to common iliac LN 
M0 - no metastases 
M1 - distant metastases

Question 11

What is the management of ow risk non-muscle invasive cancer?

Answer 11

TURBT in isolation then a single dose of intravesical mitomycin C (transurethral resection of bladder tumour)

Question 12

What is rx of intermediate non-muscle invasive ca?

Answer 12

6 doses of intravesical mitomycin C (+ diagnostic TURBT)

Question 13

What is the rx of high risk non-muscle invasive bladder ca?

Answer 13

2nd TURBT (+ original one done at diagnosis)
Intravesical BCG or radical cystectomy

Question 14

What is rx of high risk recurrent non-muscle invasive bladder ca?

Answer 14

fulguration - radio frequency ablation

Question 15

What is the treatment of muscle invasive bladder cancer?

Answer 15

i. neoadjuvant chemo - cisplatin combo regime
ii. radical cystectomy or radical radio
iii. adjuvant chemo

Question 16

What is the treatment of locally advanced or metastatic bladder cancer?

Answer 16

1st line - chemo - cisplatin (carboplatin +gemcitabine)
Managing sx:
- Bladder -> palliative hypofractionated radiotherapy
- Loin pain/sx of renal failure -> percutaneous nephrostomy or retrograde stenting

Question 17

What is BCG ?

Answer 17

immunotherapy use to treat non-muscle invasive (TB vaccine)

Question 18

What is intravesical mitomycin C?

Answer 18

chemotherapy drug that provides earliest and most effective prophylaxis against tumour cell reimplantation at TURBT