Bladder Carcinoma

Question 1

What is the most common type of bladder cancer?

Answer 1

90% of bladder ca are transitional cell carcinomas

Question 2

What types of cancer may follow schistosomiasis?

Answer 2

adenocarcinomas or squamous cell carcinomas of the bladder

Question 3

What % of bladder ca penetrate the muscle?

Answer 3

20% penetrate the muscle, this increases risk of mortality to 50% at 5 years.

Question 4

What is the presentation of bladder ca?

Answer 4

• painless haematuria
• recurrent UTIs
• similar symptoms to UTI e.g frequency, urgency, nocturia, poor flow.

Question 5

What are the risk factors of bladder ca?

Answer 5

• smoking
• exposure to industrial carcinogens e.g. in rubber factories,
• chronic / recurrent cystitis
• schistosomiasis (increased risk of adenocarcinoma / scc)
• pelvic irradiation

Question 6

What tests are done for bladder ca?

Answer 6

1) urine cytology (malignant cells present? sterile pyuria)
2) Renal imaging (CT (staging) , US, MRI (lymph node mets?) )
3) cytoscopy

Question 7

What is the management of bladder ca?

Answer 7

depends on stage / grade.

1) Superficial bladder tumours = diathermy of tumour via transurethral resection with follow up cytoscopies.

= chemo injections into bladder e.g. doxorubicin or mitomycin

2) Invasive tumours:
- radical cystectomy if less than 70yrs
- radical radiotherapy if 70+ yrs
- post op chemo

Question 8

What is the gold standard treatment for invasive tumours in pts less than 70yrs

Answer 8

radical cystectomy

Question 9

What is the treatment for T4 bladder cancer?

Answer 9

palliative chemo/radio for symptom relief.

+ catheterisation

Question 10

How often should pts be followed up after treatment of bladder cancer?

Answer 10

High risk:
- every 3 months for the first 2 yrs. then every 6months

Low risk:
follow up cystoscopy after 9 months then yearly.

Question 11

What is the pattern of bladder tumour spreading?

Answer 11

1) Local –> pelvic structures
2) Lymphatic —> iliac + para-aortic nodes
3) haematogenous —> liver and lungs.

Question 12

What is the 3 yrs survival of bladder cancer that is T2 /T3 if the surgery is done at the age of 65-75 yrs?

Answer 12

Bladder tumour T2 / T3
Age 65 - 75
3yr survival = 60%

(this falls to 40% if 75-82yrs)

Question 13

What is the 3yr survival of bladder ca with bilateral or para-aortic node involvement?

Answer 13

0 (nil)

Question 14

What are the complications of cystectomy?

Answer 14

• sexual / urinary malfunction
• massive bladder haemorrhage

-

Question 15

Is asymptomatic, non visible haematuria significant?

Answer 15

asymptomatic non visible haematuria is the only presenting feature in 4% of bladder cancers and can be detected via urine dipstick.