Bladder cancer

Question 1

Types

Answer 1

Transitional cell carcinoma (most common)

Squamous cell and associated with schisto

Transitional cell cell carcinoma: 70%

• Risk factors: Smoking, alanine dye, cyclophosphamide

Squamous cell carcinoma 5-10% (this is higher in countries where schistosomiasis is endemic) (due to transitional cells of bladder uroethilium undergoing metaplasia)

• Risk factors: Smoking, schistosomiasis exposure

Adenocarcinoma: 2%

Question 2

Clinical features

Risk Factor

Answer 2

Painless frank haematuria

Risk factor:

• Smoking
• Exposure to dyes
• Schisto (squamous cell)

Question 3

Investigations

Answer 3

Bedside: urine dip Bloods

2 week wait investigations for haematuria:

• CT urogram
• Biopsy via cystoscopy

Also need: CT for staging

Question 4

Managment

Answer 4

NOT INVADING THE MUSCLE (T1)

• Transurethral Resection of a Bladder Tumour (TURBT)
• Chemo into bladder after surgery (use barrier contraception afterwards)
• Weekly treatments for 6 weeks with BCG vaccine squirted into the bladder via catheter, then every six months for 3 years.

MUSCLE INVASIVE BLADDER (T2)

• Radical cystectomy with ileal conduit
• Radiotherapy (as neoadjuvant, primary treatment or palliative)
• IV chemotherapy as neoadjuvant or palliative