Bladder Cancer Flashcards
Bladder cancer is the __ most common cancer in the US?
6th
Bladder cancer is the __ most prevalent malignancy in the men?
4th
What percentage of bladder cancer occurs in men?
75%
What demographic group is more susceptible to bladder cancer?
White 2x more than blacks, however black have higher incidence of advanced disease
What are the two important prognostic factors?
Tumor extent and depth of muscle invasion
What does the histological prognostic factor entail?
Whether the cells are poorly or well differentiated
What does the morphological prognostic factor entail?
the different between papillary tumors being low grade and superficial, while invasive lesions are high grade and have high chance of invasion into lymphatics, BV, and tissue
What was the survival rate from 2006-2012 for bladder cancer?
77.5%
What percentage of bladder cancers are in situ?
50%
What can the bladder be described as?
Flexible, muscular, tetrahedral bag
What is the function of the bladder?
To collect urine from the kidneys via the ureters
What is the average volume the bladder can hold?
2 cups
What structure aids in the elimination of urine from the bladder?
urethera
What is the difference between the male and female urethera?
Female urethra is shorter
What is the most superior and anterior portion of the bladder called?
Apex
Do ureters pierce the base of the bladder laterally, posteriorly or neither?
Neither, Obliquely
What is the trigone of the bladder and what structures define it?
The trigone is a triangular portion of the lower bladder and it is defined by bother of the ureter orifices and urethra orifice
What type of cell lines the bladder?
Transitional Epithelium
What are the risk associated with bladder cancer? (7 answers)
Smoking, Age, Chronic Bladder Inflammation, High saturated fat diet, EBRT, workers in rubber or dye industries, Well water in New England
How much more likely are smokers to get bladder cancer then non-smokers?
3 times more likely
What does bladder cancer symptoms present as? (4 answers)
Hematuria, urine retention, clotting, Vesical irritability
What percentage of patients will present with hematuria?
75-80%
What percentage of patients will present with vesical irritability?
25%
What symptoms are more likely for bladder carcinoma in situ? (4 answers)
frequency, urgency, dysuria and hematuria
What are some methods used to detect bladder cancer? (5 answers)
Rectal/Pelvis exam, Urinalysis, Cystoscopy, Biopsy, Bone scans for mets,
What percentage of bladder cells are epithelial cells?
98%
What are the different percentages of bladder cancer based on cellular makeup? (3 answers)
92% Transitional Carcinoma, 6-7% are Squamous Cell Carcinoma, 1-2% Adenocarcinomas
What is the route of spread for bladder cancer?
Direct extension into or through the bladder wall
What is likely after the spread of bladder cancer extends through the mucosal surface? (2 answers)
Lymphatic and Bloodstream invasion
What is the primary lymphatic drainage of the bladder? (4 answers)
Internal/External iliacs, presacral and Para-aortics
What are the most common sites of metastasis for bladder cancer? (3 answers)
Lung, bone and Liver
What percentage of all bladder cancers are superficial bladder cancer?
75-85%
What is the standard of care for superficial bladder cancer?
TURBT (Transurethral resection of Bladder tumor)
What is often given after TURBT?
Intravesical Therapy
What is the a requirement for Electrofulguration of bladder cancer?
Muscle must be seen in specimen
What percentage of bladder cancer reoccur?
30%
What are the factors of reoccurring bladder cancer? (4 answers)
Grade, Depth, Multifocality, and in-situ
What is the standard of care for muscle-invasive bladder cancer?
Radical Cystectomy
What is removed for radical cystectomy for males? (8 answers)
Bladder, Adipose tisssue, Lower ureters, prostate, SV, Vas deferens, Proximal urethera, and pelvis LNs
What is removed for radical cystectomy for females? (7 answers)
Bladder, urethra, uterus, fallopian tubes, ovaries, anterior vaginal wall, pelvis LNs
What is restructured as the bladder for the patient following cystectomy?
Ileal conduit, which is a portion of small bowel reconstructed to be utilized as for connection to the ureters and stoma
What is an orthotopic neobladder?
a newly reconstructed bladder from intestine which is connected to the ureters and the urethra to function as a bladder
When is radiation therapy used for bladder cancer?
For extensive disease or inoperable patients
TURBT is often utilized before XRT or chemotherapy. True or False?
True
When utilized is radiotherapy utilized alone or with chemotherapy for bladder cancer?
Concurrent chemoradiation
What are the simulation steps for bladder patients? (5 answers)
Supine, contrast (via catheter) and air within the bladder, barium within the rectum and legs straight
Why is it essential that the legs are not bent during radiotherapy for bladder cancer?
To not shift the bladder superiorly and exposing more of the genitals
What structures are often included in the treatment portals for bladder cancer? (5 answers)
Total bladder, Tumor volume, Prostate, Prostatic Urethra, and Pelvic LNs
What are the radiation treatment fields used for bladder cancer? (2 answers)
4 field box with 12x12 field size
What is th NCCN dosage for bladder cancer including the boost? (2 answers)
40-45 Gy w/ or w/o Pelvic LN, Boost to 66 Gy
