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Urological Cancers > Bladder Cancer > Flashcards

Bladder Cancer Flashcards

1
Q

what is most common type of bladder cancer and what are the other ones

A

TCC - 80%

SCC - 20%

Adenocarcinoma

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2
Q

What is the main risk factor for bladder TCC

A

Smoking

Occupation aromatic amine exposure - dyes

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3
Q

what are the risk factors for Bladder SCC

A

Long term catheters
Reccurent UTI
Schistosomiasis

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4
Q

How is bladder cancer generally detected

A

Flexible cystoscopy

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5
Q

What is the initial management of bladder cancer after detection

A

Trans-urethral resection of bladder tumour

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6
Q

What is TURBT

A

Surgeons resect the bladder tumor and whilst resecting it they can only remove the tumor and part of the detrusor muscle underneath therefore can only tell if it is muscle invasive or not as you cant go in deeper to see how far the cancer spreads into the muscle.

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7
Q

Why is TURBT useful

A

It can help assess the tumor into its type - TCC or SCC and allows for grading and staging.

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8
Q

During the TURBT if the cancer looks superficial what is given

A

Single dose of intravesical mitomycin.

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9
Q

What stage does bladder cancer become muscle invasive

A

T2 onwards

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10
Q

What are the different stages of bladder cancer

A 
Based on TNM
Tis
Ta
T1
T2 - MUSCLE INVASIVE AT THIS POINT 
T3
T4
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11
Q

How are superficial bladder tumours classified after resection

A

Low risk

Intermediate

High

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12
Q

What are the features of low risk superficial bladder cancer

A

G1/2 , Ta, Solitary

G = grade

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13
Q

What are the features of intermediate risk superficial bladder tumours

A

G1/2 Ta - large/multiple

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14
Q

What are the features of high risk superficial bladder tumour

A

G3, T1/‘Tis/Ta,

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15
Q

What is the treatment for low risk superficial bladder tumours

A

Cystoscopic surviellance only

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16
Q

What is the treatment for intermediate risk superficial bladder cancer

A

Weekly mitomycin instillations for 6 weeks

Followed by surveillance

17
Q

What is the treatment for high risk superficial bladder tumour

A

BCG regimen

18
Q

What is the importance of the BCG regimen and how does it work

A

Given intravesically, stimulates type 4 hypersensitivity reaction that activates immune cells to tumour antigens

BCG is important as it reduces progression! Mitomycin only reduces Recurrence

19
Q

What are the side effects of BCG

A 
UTI
Dysuria 
Frequency 
Urgency 
Haematuria
20
Q

What is the treatment if BCG fails

A

Cystectomy

21
Q

How do you treat muscle invasive disease that is organ confined

A

Neoadjuvant chemo + cystectomy

Chemo RT after

22
Q

How do you treat muscle invasive disease that is metastatic

A

Palliative chemo

23
Q

What is the radical cystectomy in males

A

Aka - cystoprostatectomy

Remove the bladder, and prostate, urethra too if diseased

24
Q

what is the radical cystectomy in females

A

aka - Anterior exenteration

Removes the bladder, uterus, tubes, ovaries, anterior vaginal wall as its close to the bladder

25
Q

Now that the bladder is gone, what are 3 urinary diversions used

A
  1. Ileal conduit
  2. Neo bladder
  3. Continent cutaneous diversion
26
Q

What is a ileal conduit

A

Small bowel is resected and brought out as a stoma and two ureters attached on to that

Drains out into stoma bag

27
Q

what is a neo bladder

A

A bladder made out of small bowel and connected to the urethra

Pt voids through gravity

28
Q

what is a Indianna pouch aka - continent cutaneous diversion

A

A reservoir for urine is made. This has to be catheterised as opposed to draining in the stoma bag like Ileal conduit

29
Q

What are the contraindications for continent diversion

A

Renal impairment

Crohn’s disease

30
Q

what are the contraindications for neobladder

A

If there is prostate Involvement

31
Q

Problems with continent diversions eg - neobladder and indianna pouch

A

Hyperchloraemic metabolic acidosis - if the urine stays in the reservoir, the chloride starts to get aborted, leading to a decreased Bicarb.

Stone formation
Perforation
Mucus

Urological Cancers (7 decks)

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