Bladder Cancer and Interstitial Cystitis Flashcards
Where does bladder cancer arise?
From the endothelial lining (urothelium)
List 4 risk factors for bladder cancer
- Smoking
- Increased age
- Aromatic amines (dye and rubber industries)
- Schistosomiasis (squamous cell carcinoma)
Typical exam presentation of bladder cancer?
Retired dye factory worker with painless haematuria
Dye factory workers are associated with what type of bladder cancer?
Transitional cell carcinoma of the bladder
List 2 types of bladder cancer
- Transitional cell carcinoma (90%)
- Squamous cell carcinoma (5% – higher in areas of schistosomiasis)
- Rarer causes are adenocarcinoma, sarcoma and small-cell carcinoma
Schistosomiasis is associated with what type of bladder cancer?
Squamous cell carcinoma
What is the key presenting symptom of bladder cancer?
Painless haematuria
What are the NICE guidelines for a two week wait referral for suspected bladder cancer?
- >45 with unexplained visible haematuria +/- UTI or persisting after treatment for a UTI
- >60 with microscopic haematuria PLUS Dysuria or raised WCC
When do NICE recommend a non-urgent referral?
>60 with recurrent unexplained UTIs
Gold standard diagnosis for bladder cancer?
Cystoscopy
(rigid or flexible, under local or general)
Staging for bladder cancer?
TNM staging
What TNM staging indicates non-muscle-invasive bladder cancer?
- Tis/carcinoma in situ: flat + only affects the urothelium
- Ta: only affects the urothelium + projecting into the bladder
- T1: invading CT layer beyond the urothelium, but not the muscle layer
What TNM staging indicates Invasive bladder cancer?
Includes T2 – 4 and any lymph node OR metastatic spread
Treatment options for Bladder Cancer?
- Non-muscle-invasive: TURBT
- Recurrences or higher grade: Intravesical chemotherapy
- T2 disease: Radical cystectomy with ileal conduit
List 4 options for for draining urine following a cystectomy
- Urostomy with an ileal conduit (most common)
- Continent urinary diversion
- Neobladder reconstruction
- Ureterosigmoidostomy
What is a Urostomy?
Used to drain urine from the kidney, bypassing the ureters, bladder and urethra
Most common and popular solution after cystectomy
What is Interstitial cystitis?
Chronic condition causing inflammation in the bladder, resulting in LRT symptoms and suprapubic pain
How does Interstitial cystitis present?
Similar to a LUTI, but are more persistent. Typical presentation is more than 6 weeks of:
- Suprapubic pain, worse with full bladder, relieved by emptying bladder
- Frequency
- Urgency
- Symptoms may be worse during menstruation
Investigations for suspected interstitial cystitis?
Exclude other causes of symptoms:
- Urinalysis for UTI
- Swabs for STIs
- Cystoscopy for bladder cancer
- Prostate examination for prostatitis, hypertrophy or cancer
List 2 findings on cystoscopy of interstitial cystitis
Hunner lesions (5-20%): red, inflamed patches of the bladder mucosa associated with small blood vessels
Granulations: tiny haemorrhages on the bladder wall
