Bladder Cancer and Interstitial Cystitis

Question 1

Where does bladder cancer arise?

Answer 1

From the endothelial lining (urothelium)

Question 2

List 4 risk factors for bladder cancer

Answer 2

1. Smoking
2. Increased age
3. Aromatic amines (dye and rubber industries)
4. Schistosomiasis (squamous cell carcinoma)

Question 3

Typical exam presentation of bladder cancer?

Answer 3

Retired dye factory worker with painless haematuria

Question 4

Dye factory workers are associated with what type of bladder cancer?

Answer 4

Transitional cell carcinoma of the bladder

Question 5

List 2 types of bladder cancer

Answer 5

1. Transitional cell carcinoma (90%)
2. Squamous cell carcinoma (5% – higher in areas of schistosomiasis)
3. Rarer causes are adenocarcinoma, sarcoma and small-cell carcinoma

Question 6

Schistosomiasis is associated with what type of bladder cancer?

Answer 6

Squamous cell carcinoma

Question 7

What is the key presenting symptom of bladder cancer?

Answer 7

Painless haematuria

Question 8

What are the NICE guidelines for a two week wait referral for suspected bladder cancer?

Answer 8

1. >45 with unexplained visible haematuria +/- UTI or persisting after treatment for a UTI
2. >60 with microscopic haematuria PLUS Dysuria or raised WCC

Question 9

When do NICE recommend a non-urgent referral?

Answer 9

>60 with recurrent unexplained UTIs

Question 10

Gold standard diagnosis for bladder cancer?

Answer 10

Cystoscopy

(rigid or flexible, under local or general)

Question 11

Staging for bladder cancer?

Answer 11

TNM staging

Question 12

What TNM staging indicates non-muscle-invasive bladder cancer?

Answer 12

• 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

Question 13

What TNM staging indicates Invasive bladder cancer?

Answer 13

Includes T2 – 4 and any lymph node OR metastatic spread

Question 14

Treatment options for Bladder Cancer?

Answer 14

• Non-muscle-invasive: TURBT
• Recurrences or higher grade: Intravesical chemotherapy
• T2 disease: Radical cystectomy with ileal conduit

Question 15

List 4 options for for draining urine following a cystectomy

Answer 15

1. Urostomy with an ileal conduit (most common)
2. Continent urinary diversion
3. Neobladder reconstruction
4. Ureterosigmoidostomy

Question 16

What is a Urostomy?

Answer 16

Used to drain urine from the kidney, bypassing the ureters, bladder and urethra

Most common and popular solution after cystectomy

Question 17

What is Interstitial cystitis?

Answer 17

Chronic condition causing inflammation in the bladder, resulting in LRT symptoms and suprapubic pain

Question 18

How does Interstitial cystitis present?

Answer 18

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

Question 19

Investigations for suspected interstitial cystitis?

Answer 19

Exclude other causes of symptoms:

• Urinalysis for UTI
• Swabs for STIs
• Cystoscopy for bladder cancer
• Prostate examination for prostatitis, hypertrophy or cancer

Question 20

List 2 findings on cystoscopy of interstitial cystitis

Answer 20

Hunner lesions (5-20%): red, inflamed patches of the bladder mucosa associated with small blood vessels

Granulations: tiny haemorrhages on the bladder wall