Bladder cancer

Question 1

Epidemiology of bladder cancer

Answer 1

Bladder cancer is the 4th most common cancer in men, and the 11th most common in women.

The overall mortality is around 50%, with the

Male lifetime risk of developing bladder cancer being 1 in 40, and 1 in 108 in women. 

Question 2

Signs and symptoms of bladder cancer

Answer 2

• Painless gross haematuria: Present through-out the urinary stream, 
• Irritative bladder symptoms: Dysuria, urgency and increased frequency, 
• Recurrent UTIs: Squamous cell carcinoma, 
• Pelvic or bone pain: Lower-extremity oedema and flank pain, 
• Palpable mass: Indicative of a severely enlarged tumour. 

Haematuria present at the start of the urinary stream is normally indicative of urethral damage, whereas terminal haematuria suggests kidney damage. 

Question 3

Bladder cancer risk factors

Answer 3

• Smoking: Increased risk by 2-4-fold, 
• Occupational carcinogens: Aromatic amines, dyes, rubbers, textiles, paint and leather, 
• Age > 55 years, 
• Pelvic radiation secondary to gynaecological malignancy, 
• Male sex 5:2,  
• Family history, 
• Chronic urinary tract infections: Squamous cell carcinoma, 
• Schistosomiasis. 

80% are associated with environmental exposure

Question 4

Types of bladder cancer

Answer 4

• 90-95% are transitional cell
• 3-4% are SCC

1-2% adenocarcinomas

Question 5

P53 independent vs p53 dependent bladder cancer

Answer 5

p53 independent: superficial, non-muscle cancers, confined to epithelium with no invasion into bladder wall, tumours form papillary masses

p53 dependent: nodular, invasive cancers, high grade and rapidly proliferate

Question 6

Treatment options for bladder cancer

Answer 6

Non-muscle invasive bladder tumour management:

• Transurethral resection of bladder tumours (TURBT), 
• Low grade tumours undergo cystoscopic surveillance every 5-10 years. 

Moderately high grade non-muscle invasive management:

• Intravesical chemotherapy: Mitomycin C cisplatin based, 
• Intravesical immunotherapy: BCG, 
• Cystoscopic surveillance. 

Locally invasive bladder tumour management:

• Radical or partial cystectomy with regional lymph node dissection 
• Neoadjuvant cisplatin chemotherapy. 

Metastatic disease:

• Palliative chemotherapy, 
• Palliative radiotherapy for local symptom control