Bladder Cancer And Haematuria

Question 1

What is the 2 week referral for bladder cancer?

Answer 1

Aged 45 or over with:
Haematuria without UTI or persisting after successful treatment of UTI

Aged 60 or over and unexplained haematuria

Question 2

What is the referral criteria for renal cancer?

Answer 2

Aged 45 or more with
Unexplained haematuria which persists without UTI or successful treatment of UTI

Question 3

What imaging is used for visible haematuria?

Answer 3

First line is CT urogram and Cystoscopy to assess for bladder cancer

Cystoscopy visualises the thermal lining of the bladder

Question 4

What imaging is used for suspicion of upper uTI malignancy?

Answer 4

CT urogram

Question 5

What is CT KUB without contrast used for?

Answer 5

Kidney stones

Question 6

What is CT KUB with contrast used for?

Answer 6

Renal tumours gold standard

Question 7

What is the FIRST line imaging for renal cancer?

Answer 7

Ultrasound non contrast

->CT KUB with contrast is indicated for metastasis suspicion and is gold standard

Question 8

How does renal cell caricnoma present?

Answer 8

Haematuria
Ion pain
Flank mass

Question 9

What are the features of renal cell carcinoma?

Answer 9

adenocarcinoma of the renal cortex that originates from PCT.

They have a yellowish appearance denoting their high fat and glycogen content

Question 10

What are the hstological features of transitional cell carcinoma?

Answer 10

Papillary or flat with areas of squamous differentiation and keratinisation.

Question 11

How are T1 renal cancer managed?

Answer 11

Partial nephrectomy

Question 12

How are T2 renal cancer managed?

Answer 12

Radial nephrectomy

Question 13

How are transitional cell carcinomas affecting rnela pelvis and ureters managed?

Answer 13

Radical nephroureterectomy to remove kidney and ureteric

Question 14

How are renal cancers with inadequate reserve n contralateral kidney managed?

Answer 14

Partial nephrectomy

Question 15

What is the cause pf pseudo haematuria?

Answer 15

Myoglobin, aossicated iwth trauma

Medicaiton of rifampicin, doxorubicin, phenytoin, phenazopyridine, phenothiazine and daunomycin
Menstruation

Question 16

What are the risk factors for transitional cell carcinoma?

Answer 16

Smoking
Workplace dye exposure
Age

Question 17

What are the risk factors for squamous cell carcinoma?

Answer 17

Chronic inflammation of the bladder with long term catheter
History of schistosomiasis
Repeated UTIs
Smoking is less common than in transitional cel

Question 18

What is a protective factor against bladder cancer?

Answer 18

TB infection

Question 19

What does clot retention indicate?

Answer 19

BPH

Prostate cancer

-> raised pSA points towards prostate cancer

Question 20

What does painless haematuria indicate?

Answer 20

Bladder cancer

Renal cancer

Question 21

What does haematuria indicate?

Answer 21

Bladder cancer unless proven otherwise, therefore refer to 2 week wait haematuria clinic

Question 22

What is the test of choice for detecting haematuria?

Answer 22

Urine dipstick

Urine dipstick is a simple and commonly used test for detecting the presence of blood in urine.

Question 23

How is persistent non-visible haematuria defined?

Answer 23

Blood being present in 2 out of 3 samples tested 2-3 weeks apart

This definition helps to distinguish between transient and persistent conditions.

Question 24

What additional checks should be performed alongside haematuria testing?

Answer 24

Renal function, albumin:creatinine (ACR) or protein:creatinine ratio (PCR), and blood pressure

These checks help assess kidney health and potential complications.

Question 25

What factor significantly affects the number of red blood cells detected in urine microscopy?

Answer 25

Time to analysis ## Footnote Delays in analysis can lead to degradation of cells, affecting test accuracy.

Question 26

When were the NICE urgent cancer referral guidelines updated?

Answer 26

2015 ## Footnote These guidelines are crucial for timely diagnosis and treatment of potential cancers.

Question 27

What are the criteria for urgent referral for patients aged 45 and older?

Answer 27

Unexplained visible haematuria without urinary tract infection, or visible haematuria that persists or recurs after treatment of urinary tract infection ## Footnote These criteria aim to identify serious underlying conditions promptly.

Question 28

What are the criteria for urgent referral for patients aged 60 and older?

Answer 28

Unexplained non-visible haematuria with either dysuria or a raised white cell count on a blood test ## Footnote This helps in identifying possible infections or malignancies.

Question 29

What is the criteria for non-urgent referral for patients aged 60 and older?

Answer 29

Recurrent or persistent unexplained urinary tract infection ## Footnote This indicates the need for further evaluation to rule out serious conditions.

Question 30

What is the most common type of bladder malignancy?

Answer 30

Urothelial (transitional cell) carcinoma (>90% of cases) ## Footnote Urothelial carcinoma accounts for the majority of bladder cancer cases.

Question 31

What percentage of bladder malignancies are squamous cell carcinoma?

Answer 31

1-7% ## Footnote The incidence varies, especially in regions affected by schistosomiasis.

Question 32

What is the percentage of adenocarcinoma cases in bladder malignancies?

Answer 32

2% ## Footnote Adenocarcinoma is a less common type of bladder cancer.

Question 33

How are superficial lesions of bladder malignancies typically managed?

Answer 33

Using TURBT in isolation ## Footnote TURBT stands for transurethral resection of bladder tumor.

Question 34

What treatment options are available for patients with T2 disease?

Answer 34

Surgery (radical cystectomy and ileal conduit) or radical radiotherapy ## Footnote T2 disease indicates muscle-invasive bladder cancer.

Question 35

What is the most important risk factor for urothelial carcinoma in western countries?

Answer 35

Smoking ## Footnote The hazard ratio for smoking is around 4.

Question 36

What types of occupational exposure are considered risk factors for urothelial carcinoma?

Answer 36

Aniline dyes, rubber manufacture ## Footnote Examples of aniline dyes include 2-naphthylamine and benzidine.

Question 37

What chemotherapy agent is a risk factor for urothelial carcinoma?

Answer 37

Cyclophosphamide ## Footnote Cyclophosphamide is used in some chemotherapy regimens.

Question 38

What is the primary risk factor for squamous cell carcinoma of the bladder?

Answer 38

Schistosomiasis ## Footnote Schistosomiasis is more prevalent in certain regions.

Question 39

True or False: Smoking is a risk factor for both urothelial and squamous cell carcinoma of the bladder.

Answer 39

True ## Footnote Smoking is a common risk factor for multiple types of bladder cancer.

Question 40

How is carcinoma in situ managed?

Answer 40

Transurethral resection of superficial lesion

Question 41

How is invasive bladder cancer treated?

Answer 41

Radical cystectomy