Bladder Cancer

Question 1

Types of bladder cancer

Answer 1

• 90% transitional cell carcinoma
• 10 % squamous cell carcinomas
• Rarer causes are adenocarcinoma, sarcoma, small cell

Question 2

Features of bladder cancer

Answer 2

• Arise from the endothelial lining (urothelium)
• The typical presentation is painless haematuria
• Diagnosed by cystoscopy and biopsy
• The majority are superficial (not invading the muscle) at presentation
• Staged by the TNM system
• Risk factors
  
  • Smoking
  • Carcinogens include aromatic amines, polycyclic aromatic hydrocarbons, arsenic and tetrachloroethylene. These are found in hair dyes, industrial paint, rubber, motor, leather, and rubber workers, blacksmiths etc.
• Schistosomiasis causes squamous cell carcinoma in countries with a high prevalence
• Drinking sufficient water is thought to be protective

Question 3

Treatment of bladder cancer

Answer 3

• Not invading the muscle
  
  • Transurethral Resection of a Bladder Tumour (TURBT)
  • Chemo into bladder after surgery (use barrier contraception afterwards)
  • Mitomycin reduces risk of recurrence
  • High grade superficial can get intravesical BCG therapy
• Muscle-invasive bladder cancer
  
  • Radical cystectomy with ileal conduit
  • Radiotherapy (as neoadjuvant, primary treatment or palliative)
  • IV chemotherapy as neoadjuvant or palliative
• Metastatic TCC get M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin)