Bladder Carcinoma Flashcards
What is bladder cancer?
90% of bladder cancers are transitional cell cancer.
Adenocarcinoma and squamous cell carcinoma rare in the west.
The bladder is lined with transitional cell epithelium, as is the calcyes, renal pelvis, ureter and urethra.
Who does it affect?
Male > female (4:1)
Bladder cancer 50x more common than ureter or renal pelvis
Rare in under 40 years old
What are the predisposing factors for bladder cancer?
Smoking
Exposure to industrial carcinogens i.e. beta-napthylamine and benzidine (workers in petroleum, chemical, cable and rubber industries high at risk)
Aromatic amines (rubber industry)
Chronic cystitis
Exposure to drugs e.g. phenacetin, cyclophosphamide
Chronic inflammation i.e. schistosomiasis usually assoc. with squamous cell carcinoma
What are the clinical features of bladder cancer?
Painless haematuria (most common symptom ; 80% experience this)
Pain may result from local nerve involvement
Symptoms of UTI in absence of significant bacteriuria suggestive of bladder cancer i.e frequency, urgency, dysuria, urinary tract obstruction
Flank pain with urinary tract obstruction in ureteric lesions
What investigations are carried out for suspected bladder cancer?
Urine cytology for malignant cells
Urinary tumour markers
Cystoscopy to assess the tumour burden & biopsy
CT of the pelvis is diagnostic and provides staging
MRI may show pelvis lymph node involvement
How is bladder tumour staged?
TNM staging
Tis : carcinoma in situ
Ta : Tumour confined to epithelium
T1 : Tumour in submucosa or lamina propria
T2 : Invades muscle
T3 : Extends into perivesical fat
T4 : Invades adjacent organs
N0 : No lymph node involvement
N1-3 : Lymph node involvement
M0 : No metastases
M1 : Distant metastases
How do you manage superficial bladder cancer?
Tis/Ta/T1 (80% of all patients) => Diathermy via transurethral cystoscopy or transurethral resection of bladder tumour (TURBT)
Recurrent superficial transitional cell carcinoma treated with mycobacterium BCG installed in the bladder => activates immune destruction of cancer cells
Alternatively = cytotoxic drug i.e. gemcitabine or mitimycin
How do you manage invasive bladder cancer?
Neoadjuvant chemotherapy e.g. gemcitabine followed by either surgery (cystectomy) or chemoradiotherapy
T2-T3 => radical cystectomy is gold standard => ill conduit and stoma formation, rarely neobladder can be formed => allowing more normal micturition
How do you manage metastatic bladder cancer?
T4 => usually palliative chemotherapy i.e. cisplatin or immunotherapy i.e. PD-1.
Chronic catheterization and urinary diversions may help to relieve pain.
How does bladder cancer spread?
Local => pelvic structures
Lymphatic => iliac and para-aortic nodes
Haematogenous => liver and lungs
What are the complications of bladder cancer?
Cystectomy => sexual and urinary malfunction
Massive bladder haemorrhage
