Bladder Cancer

Question 1

Bladder Cancer Histology

Answer 1

• 90% are transitional cell carcinomas
• The rest are squamous
• Can be non-invasive papillary tumour
• Can be solid non-papillary tumour that invades bladder wall and has high propensity for metastasis

Question 2

Bladder Cancer Epidemiology

Answer 2

• Seventh most common cancer in the UK
• Most frequently occurring tumour of urinary system
• Most over 60, mostly male

Question 3

Bladder Cancer RFs

Answer 3

• Main RF is age
• Half are caused by smoking
• Carcinogens are renally excreted
• Industrial plants processing paint, dye, metal, petroleum, rubber and textiles

Question 4

Bladder Cancer Presentation

Answer 4

• Painless, gross haematuria in 80-90%
• Usually no abnormality on standard physical examination
• Advanced disease can cause voiding problems
• Only 5% have invasive disease on presentation

Question 5

Bladder Cancer Urgent Referral Guidelines

Answer 5

• Adults over 45 with unexplained haematuria without UTI following successful treatment of UTI
• Adults over 60 with unexplained non visible haematuria and dysuria or raised WCC

Question 6

Bladder Cancer Differentials

Answer 6

• Haemorrhagic cystitis
• Nephrolithiasis
• Renal cancer

Question 7

Bladder Cancer Investigations

Answer 7

• Urinalysis and culture to exclude infection
• Bloods
• USS
• CT for more detail
• Cystoscopy

Question 8

Bladder Cancer Management

Answer 8

• TURBT if non-invasive
• Immediate post-op intravesical chemotherapy
• If invasive, radical cystectomy with lymph node clearance
• Chemotherapy in advanced stages