Bladder cancer

Question 1

What are types of bladder cancer?

Answer 1

Mostly urothelial carcinoma

Question 2

What are risk factors for bladder cancer?

Answer 2

Male
Aged 50-80
Smoking
hydrocarbons
chronic inflammation e.g. stones, infections, catheter
• Drugs: cyclophosphamide, pioglizatone
Pelvic radiotherapy

Question 3

What are Sx of bladder cancer?

Answer 3

Painless frank haematuria

May be dysuria or frequency, renal colic due to clot.

Question 4

What DDx of bladder cancer

Answer 4

• UTI
• Renal calculi
Renal or prostate cancer

Question 5

What Ix in bladder cancer?

Answer 5

Urinalysis and cytology: RBC casts, and cytology shows malignant cells even in in-situ disease

Cystoscopy: take biopsy

Can do transurethreal resection for diagnosis and management, histology afterwards.

CT staging for suspected muscle invasive disease

Question 6

What is grading of bladder cancer?

Answer 6

• Grade 1 – well differentiated – good prognosis
  
  • Grade 2 – moderately differentiated
  • Grade 3 – poorly differentiated
    ○ Least common
    Most likely to progress to invasive disease

Question 7

What is Rx of non-invasive bladder cancer?

Answer 7

TURBT. Removal of tumour by diathermy during rigid cystoscopy, and take biopsies.

May need adjuvant intravesical therapy, such as Bacille Calmette-Guerin (BCG) or Mitomycin C.

Question 8

What follow up for superficial bladder tumours?

Answer 8

High risk of recurrence, so do regular surveilance with cytology and cystoscopy at 3 months

Question 9

What Rx for muscle invasive bladder cancer?

Answer 9

Radical cystectomy

Usually give neoadjuvant chemo.

Need an ileal conduit or bladder reconstruction.

Question 10

What Rx for TCC in situ?

Answer 10

Regular intravesical BCG injections

Question 11

What are complications of bladder cancer?

Answer 11

• Prostatic urothelial carcinoma
• Upper tract TCC
• Hydronephrosis
Urinary retention (clot)