Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Bladder cancer (URO) > Flashcards

Bladder cancer (URO) Flashcards

1
Q

What type of cancer is the majority of bladder cancer?

A

Transitional cell carcinoma AKA urothelial carcinoma (90%)

Rarely, cancers may be squamous cell carcinomas associated with chronic inflammation e.g. schistosomiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most causative risk factor for bladder cancer?

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the epidemiology of bladder cancer. (2)

A
  • M>F
  • > 65 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do non-invasive bladder cancers include? (3)

A
  • papillary tumours confined to the epithelial mucosa (Ta)
  • tumours invading the subepithelial tissue i.e. lamina propria (T1)
  • carcinoma in situ (Tis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do muscle-invasive bladder cancers include? (3)

A
  • organ-confined tumours: invade muscularis propria (T2a/T2b)
  • non-organ-confined tumours: invade perivesical fat (T3a/T3b)
  • tumours invade adjacent organs: prostate stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall (T4a/T4b)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What chromosomes are involved in bladder cancer?

A
  • loss of heterozygosity in chromosome 9q is common in non-invasive tumours (favourable prognosis)
  • loss of tumour suppressor genes Rb + p53 is associated with invasive tumours (unfavourable prognosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some general risk factors for bladder cancer? (9)

A
  • smoking
  • exposure to chemical carcinogens (aromatic amines in rubber/dye industries, polycyclic aromatic hydrocarbons in aluminium)
  • age>65
  • pelvic radiation
  • systemic chemotherapy
  • Schistosoma infection
  • male sex
  • chronic bladder inflammation
  • genetic predisposition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some risk factors for transitional cell carcinoma of the bladder? (7)

A
  • smoking
  • aniline dye (printing/textile industry e.g. 2-naphthylamine and benzidine)
  • rubber manufacture
  • cyclophosphamide
  • pelvic radiation
  • chronic UTIs
  • positive Fx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some risk factors for squamous cell carcinoma of the bladder? (3)

A
  • Schistosomiasis (endemic in Middle East)
  • long-term catheterisation (>10y)
  • smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which occupations are high risk for bladder cancer? (2)

A
  • painters
  • hairdressers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical features of bladder cancer? (3)

A
  • painless haematuria (gross/microscopic) - intermittent episodes, Abx failed to treat, often macroscopic
  • dysuria (painful urination) - associated with aggressive bladder cancer
  • irritative/storage Sx –> urinary frequency and urgency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the first-line investigation for bladder cancer?

A

Urinalysis (bedside Ix) - haematuria and pyuria (WCC >10/mm3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigation is key to diagnosing bladder cancer?

A

Cystoscopy and biopsy - visualises bladder tumours and enables pathological diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which investigations are done for staging bladder cancer? (5)

A
  • renal and bladder US - may see hydronephrosis due to tumour causing obstruction
  • CT/MRI abdomen and pelvis
  • imaging of upper urinary tract collecting system for non-invasive disease (Ta, Tis)
  • IV urography - may show filling defects indicative of tumour, but small tumours often not visible
  • CXR - for muscle invasive/lung metastases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What scan do we do to look for metastases in bladder cancer?

A

CXR - check for lung metastases / muscle-invasive cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What urinary biomarkers may be present in bladder cancer? (4, low yield)

A
  • bladder tumour antigen (BTA)
  • nuclear matrix protein 22 (NMP22)
  • ImmunoCyt/uCyt+
  • UroVysion
17
Q

What is the next step for a >60y with unexplained non-visible haematuria and either dysuria or raised WCC on blood test?

A

Referred via 2WW suspected cancer pathway to exclude bladder cancer

18
Q

What are some differential diagnoses for bladder cancer? (10)

A
  • BPH (enlarged prostate DRE)
  • haemorrhagic cystitis (acute onset)
  • prostatitis (men<55)
  • UTI
  • nephrolithiasis
  • renal cell carcinoma
  • renal urothelial carcinoma
  • gynaecological/pelvic cancers
  • radiation cystitis
  • diverticulitis
19
Q

Describe the TNM staging for bladder cancer.

A
  • T0: no evidence of tumour
  • Ta: non-invasive papillary carcinoma
  • T1: tumour invades sub-epithelial connective tissue (lamina propria)
  • Tis: carcinoma in situ
  • T2a: tumour invades superficial muscularis propria (inner half)
  • T2b: tumour invades deep muscularis propria (outer half)
  • T3: tumour extends to perivesical fat
  • T4: tumour invades - prostatic stroma, seminal vesicles, uterus, vagina
  • T4a: invasion of uterus, prostate or bowel
  • T4b: invasion of pelvic sidewall or abdominal wall
  • N0: no nodal disease
  • N1: single regional lymph node in true pelvis
  • N2: multiple regional lymph nodes in true pelvis
  • N3: lymph node metastasis to common iliac lymph nodes
  • M0: no distant metastasis
  • M1: distant disease
20
Q

How is non-muscle invasive and low risk bladder cancer managed?

A

Transurethral resection of bladder tumour (TURBT)

Plus immediate post-operative intravesical chemotherapy

21
Q

How is muscle-invasive (T2) bladder cancer managed?

A

Radical cystoprostatectomy - removal of bladder, prostate and seminal vesicles, with bilateral pelvic lymph node dissection

22
Q

How is metastatic (or locally advanced T4b or N2-3) bladder cancer managed?

A

Palliative systemic chemotherapy

2nd line - immunotherapy (delayed BCG, pembrolizumab, atezolizumab)

23
Q

What are some complications of bladder cancer? (4)

A
  • prostatic urothelial carcinoma
  • upper tract (renal/ureteral) urothelial carcinoma
  • hydronephrosis (tumour of trigone, urethral orifice or ureter can obstruct and cause renal damage)
  • urinary retention (tumours at bladder neck can cause outlet obstruction)
24
Q

What is the survival rate for non-invasive bladder cancer?

A

High

25
Q

What is the survival rate for metastatic bladder cancer?

A

12%

26
Q

Describe the TNM staging for bladder cancer.

A
  • T0: no evidence of tumour
  • Ta: non-invasive papillary carcinoma
  • T1: tumour invades sub-epithelial connective tissue (lamina propria)
  • Tis: carcinoma in situ
  • T2a: tumour invades superficial muscularis propria (inner half)
  • T2b: tumour invades deep muscularis propria (outer half)
  • T3: tumour extends to perivesical fat
  • T4: tumour invades - prostatic stroma, seminal vesicles, uterus, vagina
  • T4a: invasion of uterus, prostate or bowel
  • T4b: invasion of pelvic sidewall or abdominal wall
  • N0: no nodal disease
  • N1: single regional lymph node in true pelvis
  • N2: multiple regional lymph nodes in true pelvis
  • N3: lymph node metastasis to common iliac lymph nodes
  • M0: no distant metastasis
  • M1: distant disease
27
Q

Describe the prognosis of different TNM stages of bladder cancer.

A
  • T1 = 90%
  • T2 = 60%
  • T3 = 35%
  • T4a = 10-25%
  • any T, N1-N2 = 30%

Year 3 (154 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions