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CSB048 - TREATMENT 2 > Bladder (for wee wee) > Flashcards

Bladder (for wee wee) Flashcards

1
Q

Position of Bladder in Relation to Other Structures

A
  • Superior and Posterior to Pelvic Bones
  • Lies posterior to pubic symphysis
  • Anterior to the rectum
  • Inferior to the small intestine
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2
Q

Bladder Position as it Fills

A
  • Neck of bladder remains fixed to prostate (only in males) and pelvic floor muscle
  • It then rises into the pelvic cavity
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3
Q

What lines the bladder?

A

Transitional Epithelium (smooth when full) (folded when empty)

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4
Q

Epidemiology of Bladder Cancer

A
  • Peak Incidence at 65
  • More common in Caucasians
  • 3x more common in males than females
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5
Q

Aetiology of Bladder Cancer

A
  • Occupational exposure (naphthylamine = carcinogen in the dye industry)
  • Smoking
  • Chronic Bladder Infection
  • Exposure to Cyclophosphamide (immunosuppressant -> for inflammation)
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6
Q

Signs and Symptoms of Bladder Cancer

A
  • Haematuria (blood in urine, painless)
  • Urinary irritation (frequency, urgency, pain, retention, dysuria)
  • Obstruction (pain, infection, kidney damage)
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7
Q

Pattern of Lymphatic Spread for Bladder Cancer

A

Hypogastric -> Obturator -> Internal / External / Common Iliac -> Para-Aortic and Inguinal Nodes

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8
Q

Common Mets for Bladder Cancer

A
  • LN’s
  • Lung
  • Liver
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9
Q

Primary and Secondary Lymphatic Drainage for Bladder Cancer

A

Primary Drainage: External/Internal Iliac Nodes, Obturator Nodes, Pre Sacral Nodes

Secondary Drainage: Common Iliac, Para-Aortic, Inguinal Nodes

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10
Q

Pathology of Bladder Cancer

A
  • 90% are derived from TCC

- Others: Squamous Carcinoma, Adenosarcoma, Leiomyosarcoma (smooth muscle), Rhabdomyosarcoma (striated muscle)

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11
Q

Staging of Bladder Cancer

A
  • TNM Staging
  • TA = non-invasive and superficial
  • T1 = tumour invades lumina propria and mucosa
  • T2 = invades muscularis propria
  • T3 = Invades peri vesical, involves deep muscle of bladder
  • T4 = tumour invades neighbouring organs
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12
Q

Clinical Management for Superficial Bladder Cancer

A
  • Repeated Cystoscopy (involves and remove tumour when possible)
  • Cystodiathermy, cryosurgery and laser treatment
  • RT is rarely used
  • Tends to recur rather than invade -> follow up cystoscopy scheduled -> can be lifelong (if multiple occur chemo is used)
  • Adeno/Squamo is not radio sensitive -> treated with cystectomy
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13
Q

Clinical Management for Muscle-Invasive Disease

A
  • Surgery and RT is standard
  • Cisplatin prior to RT is shown to improve treatment outcome by 5%
  • Diagnosis is generally provided by cystoscopy
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14
Q

Patient Positioning and Set-up Considerations

A
  • Empty Bladder and empty Rectum
  • Supine, straight and level
  • Arms on Chest
  • Headrest
  • Knees bolster (indexed)
  • Foot stocks (indexed)
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15
Q

CT Simulation for Bladder Cancer

A
  • CT Simulation Parameters: Lower border L5 -> inferior border ischial tuberosities
  • Slice Thickness: 3-5 mm
  • Ant Tattoo = ML / 2 Lateral Tattoos
  • Confirm bladder is empty
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16
Q

Treatment Field Arrangement

A
  • Options - posterior oblique fields to reduce dose to rectum)
  • Concerns -> bowel and rectal changes / bladder movement
  • IMRT/VMAT -> dose escalation to tumour, IGRT to locate and minimise PTV
17
Q

Acute Side Effects for Bladder Cancer

A
  • Frequency/ urgency from urination from radiation cystitis (fluid intake strongly encouraged)
  • Patient may pass fragments in urine or a little fresh blood (haematuria)
  • Diarrhoea, nausea, vomiting (medication & monitor)
  • Local skin reaction: mild to moderate; fatigue
18
Q

Late Side Effects for Bladder Cancer

A
  • Fibrosis and shrinkage of the bladder (reduced bladder capacity)
  • Haematuria - bladder telangiectasia,
  • Late bowel damage,
  • Vaginal dryness and Stenosis in women
  • Impotence in men
19
Q

Criteria for RT for Patient With Bladder Cancer

A
  • Younger than 80
  • Adequate medical condition
  • Normal renal function
  • No inflammatory bowel disease
  • Good bladder function
  • TCC
  • Single tumour <7cm diameter
  • No mets
20
Q

Dose Fractionation

A

Radical: 64 Gy in 32# (daily) (across 6.5 weeks)

Palliative: 21Gy in 3# (alternate days in 1 week)
Palliative: 36Gy in 6# (given weekly for 6 weeks)

21
Q

Treatment QA for Bladder Cancer

A
  • KV imaging, kV cone beam imaging, MV imaging of gold seeds
  • If IMRT/VMAT not available -> EPI (match bones with AP and LAT DRR’s daily for first 3-5 days) (once weekly following to correct for systematic errors)

CSB048 - TREATMENT 2 (12 decks)

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