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Year 3 Conditions: Renal and Urolgy > Bladder Cancer (Complete) > Flashcards

Bladder Cancer (Complete) Flashcards

1
Q

What is the most common type of bladder cancer?

A

Urothelial carcinoma (90% of cases)

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2
Q

What are the three main types of bladder cancer?

A

Urothelial carcinoma (aka transitional cell carcinoma)

Squamous cell carcinoma

Adenocarcinoma

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3
Q

What is the biggest risk factor for developing bladder cancer?

A

Smoking

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4
Q

What are risk factors for transitional cell carcinoma?

A

Smoking

Anilline dyes (e.g. printing and textiles industry)

Rubber manufacture

Cyclophosphamide

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5
Q

Bladder cancer is more likely to affect which gender the most?

A

Males

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6
Q

How is the T part of the TNM staging criteria for bladder cancer classified?

A

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

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7
Q

A carcinoma in situ is found on imaging of the bladder. Based on the TNM critera, how should this be staged?

A

Tis

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8
Q

A non-invasive papillary carcinoma of the bladder is found on imaging. Based on the TNM critera, how should this be staged?

A

Ta

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9
Q

Biopsy of the bladder reveals a tumor invading the subepithelial tissue. Based on the TNM critera, how should this be staged?

A

T1

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10
Q

Biopsy of the bladder reveals a tumor invading the muscularis proposa. Based on the TNM critera, how should this be staged?

A

T2

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11
Q

Biopsy of the bladder reveals a tumor invading the pervesical fat. Based on the TNM critera, how should this be staged?

A

T3

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12
Q

A bladder tumor has invaded nearby structures such as the prostate and pelvic wall. Based on the TNM critera, how should this be staged?

A

T4

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13
Q

How is bladder cancer graded?

A

Grade 1: Well differentiated cells
Grade 2: Moderately differentiated cells
Gradee 3: Poorly differentiated cells

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14
Q

What criteria must be met to place bladder cancer into these categories based on the TNM system?:

N0
N1
N2
N3

A

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

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15
Q

What criteria must be met to place bladder cancer into these categories based on the TNM system?:
M0
M1a
M1b

A

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,

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16
Q

Bladder cancer most commonly presents as what symptom?

A

Microscopic haematuria

17
Q

How does haematuria tend to present usually if bladder cancer is the cause?

A

Intermittently

18
Q

Urological examination should be performed in which cases?

A

Any patient with visbile haematuria

Patients with microscopic haematuria with no obvious benign cause

19
Q

What are some of the main signs/symptoms of bladder cancer? (6)

A

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)

20
Q

List some of the risk factors associated with bladder cancer (9).

A

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)

21
Q

What specific risk factors increase the likelihood of developing squamous cell carcinoma of the bladder? (2)

A

Schistosoma Haematobium infection (parasyte common in Egypt)

Chronic UTIs

Long-term catheters (10+ years)

22
Q

What is the 1st line order to investigate in patients suspected of having bladder cancer? What finding would be present in these patients?

A

Urinalysis: Haematuria

23
Q

After haematuria has been confirmed based on urinalysis findings. What other investigations should be performed in patients suspected of bladder cancer?

A

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)

24
Q

What is the gold-standard diagnostic investigation for bladder cancer?

A

Cystocopy and biopsy

25
Q

What symptoms can differentiate a UTI from bladder cancer?

A

Back pain

Fever

Chills

Less common in bladder cancer and moresoe in UTIs

26
Q

What symptoms can differentiate renal stones (nephrolithiasis) from bladder cancer?

A

Presentation of renal colic

27
Q

What is the management plan for patients with non-muscle-invasive bladder cancer? (NMIBC)

A

If non-muscle invasive: Transurethral resection of the bladder tumor

Plus immediate post-operative intra-vesical chemotherapy

Plus delayed intravesical BCG immunotherapy (if bladder cancer is intermediate/high risk)

28
Q

What is the management plan for locally invasive bladder cancer?

A

If invading the muscle or perivesical fat (T2-T3): Radical or partial cystectomy with pelvic lymph node disection.

If involvement of nearby organs of the pelvis or metastatic: Chemotherapy

29
Q

What is the prognosis of bladder cancer?

A

All bladder cancers have a high risk of reccurence

For low-grade: Risk of disease progression and death is low

30
Q

List the 4 main complications that can arise from bladder cancer

A

Prostatic urothelial cell carcinoma (If BCG treatment not carried out in high-risk patients)

Upper tract urothelial cell carcinoma

Hydropnephrosis (Kidneys stretched out due to increased urinary retention)

Urinary retention

Year 3 Conditions: Renal and Urolgy (13 decks)

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