Bladder Cancer Flashcards
what is most common type of bladder cancer and what are the other ones
TCC - 80%
SCC - 20%
Adenocarcinoma
What is the main risk factor for bladder TCC
Smoking
Occupation aromatic amine exposure - dyes
what are the risk factors for Bladder SCC
Long term catheters
Reccurent UTI
Schistosomiasis
How is bladder cancer generally detected
Flexible cystoscopy
What is the initial management of bladder cancer after detection
Trans-urethral resection of bladder tumour
What is TURBT
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.
Why is TURBT useful
It can help assess the tumor into its type - TCC or SCC and allows for grading and staging.
During the TURBT if the cancer looks superficial what is given
Single dose of intravesical mitomycin.
What stage does bladder cancer become muscle invasive
T2 onwards
What are the different stages of bladder cancer
Based on TNM Tis Ta T1 T2 - MUSCLE INVASIVE AT THIS POINT T3 T4
How are superficial bladder tumours classified after resection
Low risk
Intermediate
High
What are the features of low risk superficial bladder cancer
G1/2 , Ta, Solitary
G = grade
What are the features of intermediate risk superficial bladder tumours
G1/2 Ta - large/multiple
What are the features of high risk superficial bladder tumour
G3, T1/‘Tis/Ta,
What is the treatment for low risk superficial bladder tumours
Cystoscopic surviellance only
What is the treatment for intermediate risk superficial bladder cancer
Weekly mitomycin instillations for 6 weeks
Followed by surveillance
What is the treatment for high risk superficial bladder tumour
BCG regimen
What is the importance of the BCG regimen and how does it work
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
What are the side effects of BCG
UTI Dysuria Frequency Urgency Haematuria
What is the treatment if BCG fails
Cystectomy
How do you treat muscle invasive disease that is organ confined
Neoadjuvant chemo + cystectomy
Chemo RT after
How do you treat muscle invasive disease that is metastatic
Palliative chemo
What is the radical cystectomy in males
Aka - cystoprostatectomy
Remove the bladder, and prostate, urethra too if diseased
what is the radical cystectomy in females
aka - Anterior exenteration
Removes the bladder, uterus, tubes, ovaries, anterior vaginal wall as its close to the bladder
Now that the bladder is gone, what are 3 urinary diversions used
- Ileal conduit
- Neo bladder
- Continent cutaneous diversion
What is a ileal conduit
Small bowel is resected and brought out as a stoma and two ureters attached on to that
Drains out into stoma bag
what is a neo bladder
A bladder made out of small bowel and connected to the urethra
Pt voids through gravity
what is a Indianna pouch aka - continent cutaneous diversion
A reservoir for urine is made. This has to be catheterised as opposed to draining in the stoma bag like Ileal conduit
What are the contraindications for continent diversion
Renal impairment
Crohn’s disease
what are the contraindications for neobladder
If there is prostate Involvement
Problems with continent diversions eg - neobladder and indianna pouch
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
