Bladder cancer

Question 1

Histological types?

Answer 1

• 90% transitional cell carcinoma
• 10% squamous cell carcinoma

Question 2

facts?

Answer 2

• arise from endothelial lining of bladder (urothelium)
• majority are superficial at presentation
• staged using TNM

Question 3

risk factors?

Answer 3

• smoking
• exposure to aromatic amines, polycyclic aromatic hydrocarbons, arsenic and tetrachloroethylene
  
  • hair dyes, industrial paint, rubber, motor etc
• Schistomiasis - Squamous Cell

Question 4

what factor is thought to be protective?

Answer 4

drinking sufficient water

Question 5

presentation?

Answer 5

painless haematuria

but also:

• recurrent UTIs
• storage symptoms

Question 6

Ix?

Answer 6

• flexible cystoscopy w biopsy - gold standard
• urine cytology useful in high grade disease

Question 7

Mx?

Answer 7

• superficial disease (not invading the muscle)
  
  • endoscopic resection- TURBT
  • injection of chemotherapy agent
  • BCG immunotherapy
• muscle-invasive disease
  
  • radical cystectomy w ileal conduit
  • radical radiotherapy
  • chemotherapy as neoadjuvant or palliative