Bladder Cancer (Complete) Flashcards
What is the most common type of bladder cancer?
Urothelial carcinoma (90% of cases)
What are the three main types of bladder cancer?
Urothelial carcinoma (aka transitional cell carcinoma)
Squamous cell carcinoma
Adenocarcinoma
What is the biggest risk factor for developing bladder cancer?
Smoking
What are risk factors for transitional cell carcinoma?
Smoking
Anilline dyes (e.g. printing and textiles industry)
Rubber manufacture
Cyclophosphamide
Bladder cancer is more likely to affect which gender the most?
Males
How is the T part of the TNM staging criteria for bladder cancer classified?
Ta: Non-invasive papillary carcinoma
Tis: Carcinoma in situe
T1: Invades subepithelial connective tissue
T2: Invades muscularis propria
T3: Invades perivesical fat
T4: Invades prostate, uterus, vagina, bowel, pelvic or abdominal wall
A carcinoma in situ is found on imaging of the bladder. Based on the TNM critera, how should this be staged?
Tis
A non-invasive papillary carcinoma of the bladder is found on imaging. Based on the TNM critera, how should this be staged?
Ta
Biopsy of the bladder reveals a tumor invading the subepithelial tissue. Based on the TNM critera, how should this be staged?
T1
Biopsy of the bladder reveals a tumor invading the muscularis proposa. Based on the TNM critera, how should this be staged?
T2
Biopsy of the bladder reveals a tumor invading the pervesical fat. Based on the TNM critera, how should this be staged?
T3
A bladder tumor has invaded nearby structures such as the prostate and pelvic wall. Based on the TNM critera, how should this be staged?
T4
How is bladder cancer graded?
Grade 1: Well differentiated cells
Grade 2: Moderately differentiated cells
Gradee 3: Poorly differentiated cells
What criteria must be met to place bladder cancer into these categories based on the TNM system?:
N0
N1
N2
N3
N0: No cancer in lymph nodes
N1: Cancer in one of the lymph nodes of the pelvis
N2: Cancer in more than one of the lymph nodes of the pelvis
N3: Cancer in the lymph nodes just outside the pelvis
What criteria must be met to place bladder cancer into these categories based on the TNM system?:
M0
M1a
M1b
M0: No metatstatic cancer
M1a: Cancer in the lymph nodes outside of the pelvis
M1b: Cancer has spread to other organs of the body (e.g. lungs, bones,
Bladder cancer most commonly presents as what symptom?
Microscopic haematuria
How does haematuria tend to present usually if bladder cancer is the cause?
Intermittently
Urological examination should be performed in which cases?
Any patient with visbile haematuria
Patients with microscopic haematuria with no obvious benign cause
What are some of the main signs/symptoms of bladder cancer? (6)
Microscopic haematuria
Haematuria
Urinary frequency (If BPH or overactive bladder is not identified)
Urinary urgency
Nocturia
Dysuria (That is not caused by UTI or irresponsive to antibiotics)
List some of the risk factors associated with bladder cancer (9).
Male (3x higher than females)
> 65 years
Smoking
Exposure to chemical carcinogens (painters and hairdressers)
Pelvic radiation
Chemotherapy
Schistosoma infection
Chronic bladder infection (e.g. recurrent UTIs, kidney or bladder stones, chronic catheristation)
Genetic predisposition (e.g. family history)
What specific risk factors increase the likelihood of developing squamous cell carcinoma of the bladder? (2)
Schistosoma Haematobium infection (parasyte common in Egypt)
Chronic UTIs
Long-term catheters (10+ years)
What is the 1st line order to investigate in patients suspected of having bladder cancer? What finding would be present in these patients?
Urinalysis: Haematuria
After haematuria has been confirmed based on urinalysis findings. What other investigations should be performed in patients suspected of bladder cancer?
Bloods:
FBC: Normal or mild aneamia
U&Es and ALP: To check if theres bone involvement. If ALP is elevated, order a bone scan.
Imaging:
Cystoscopy and biopsy (Gold-standard)
CT or MRI: To exclude kidney stones and visualise bladder cancer
CXR: If lung metasteses is suspected
Isotope bone scan: If bony metasteses suspected (e.g. elevated ALP)
What is the gold-standard diagnostic investigation for bladder cancer?
Cystocopy and biopsy
