Bladder Carcinoma

Question 1

What is it?

Answer 1

Cancer of the bladder usually caused by Transitional Cell Carcinoma

Question 2

Which cells does this arise from?

Answer 2

The specialised mucosal epithelium of Transitional cells

Question 3

How does it present histologically?

Answer 3

Either as a non-invasive papillary tumour or as a solid non-papillary tumour that invades the bladder wall and has a high propensity to metastasise

Question 4

Is it common?

Answer 4

It is the 7th most common cancer in the UK, 1 per 6000 people per year, causes 5000 deaths each year

Question 5

Who does it affect?

Answer 5

Majority occur in over 60’s, and more commonly in men 3:1

Question 6

Risk Factors (12)

Answer 6

Age, smoking, aromatic amines, polycyclic aromatic hydrocarbons, chlorinated hydrocarbons, dyes, metal, petroleum products, radiation to the pelvis, cyclophosphamide exposure, stones, indwelling catheters

Question 7

Signs and Symptoms

Answer 7

Painless haematuria, recurrent UTIs, voiding irritability, abdominal pain, weight loss, tirednes, hesitancy, dribbling, anorexia

Question 8

Differentials (5)

Answer 8

Renal cancer, prostate cancer, Haemorrhagic cystitis, Nephrolithiasis, UTI

Question 9

What bloods would you do? (4)

Answer 9

FBC, U&E, LFT, CRP

Question 10

Other investigations (6)

Answer 10

Urinalysis, Urine Culture, CT, MRI, Cytoscopy, Biopsy

Question 11

What is the treatment? (7)

Answer 11

Diathermy/transurethral resection of tumour, radical cystectomy, intravesicle chemotherapeutic agents, chemotherapy, radiotherapy, chronic catheterisation

Question 12

Complications (7)

Answer 12

UTI, Urinary retention, hydronephrosis, tumour recurrence, increased risk of TCC, radical cystectomy damages S2,3 and 4 outlet causing complete erectile dysfunction, orthoptic bladders have risk of incontinence

Question 13

Is there a good prognosis?

Answer 13

Recurrence rate is 70%, Superficial tumours have good survival, invasive 30-60%