Bladder Oncology Flashcards
1
Q
What are some aetiological factors of bladder cancer?
A
- polycyclic aromatic and analine dyes, many have been banned. hydrocarbons (oils etc people who work with)
- Hair dressers, Bus and Taxi drivers, Metal workers
- Parasites
- Smoking
- Chemical and drugs
- Physical factors, calculi (stones) and pelvic irradiation
- Family predisposition
2
Q
What is the typical pathology of bladder cancers?
A
- Benign papilloma - may still require treatment
- 80-90% transitional cell carcinoma
- CIS = carcinoma in situ, high risk of progression
- Invasive, can be nodular, papillary, sessile, ulcerated, can form nests
- SCC only 5% and harder to treat, except in N. Africa schistosomiasis. Very aggressive
3
Q
What are some associated paraneoplastic syndromes?
A
- Hypercalcaemia = calcium above normal, patient confused, bone pain, headaches etc.
- Neuromuscular syndromes: subacute cerebellar degeneration, motor neuropathy, sensory neuropathy, dermamyositis
4
Q
What are the signs and symptoms of bladder cancer?
A
- Painless haematuria (blood in urine)
- Frequency
- Dysuria
- urgency
- Burning
- Suprapubic pain - suggests inflammatory process due to infection
- Obstruction
- Ipsilateral flank pain = ureteric obstruction
- Oedema of legs or genitalia
5
Q
What diagnosis and investigations are appropriate?
A
- MSSU - looking for blood in urine
- Urine cytology, patients must be well hydrated
- FBC to assess renal and liver function
- Bi-manual examination: to determine the bulk of the disease and attachment to adjacent organs
- IVU or ultrasound of kidneys (before cystoscopy)
- Bilateral retrograde ureteropylography at cytoscopy
- transurethral biopsy
6
Q
How is Bladder cancer staged?
A
- CIS not quite spread into bladder lining
- T1a larger, encroaching on bladder wall
- T1, invasion into bladder lining and connective tissue
- T2 Spread into through connective tissue into muscle
- T3 spread into fat
- T4 local invasion into other organs
- Stage 1, no RT, 2 and 3 = radical, stage 4 radical palliation with chemo
7
Q
How does spread occur?
A
- Local infiltration is most common then peri-vesticular fat to pelvic walls and adjacent organs
- Via lymph = 30% of patients iliac and para-aortic nodes
- via blood to lungs and bone sometimes to skin or liver
- Implantation after surgery
8
Q
What are prognostic factors for bladder cancer?
A
- Histology: TCC has the best prognosis
- Invasion: poorer prognosis
- CIS often progresses to invasive carcinoma
- T2 patients have 60% 5 year survival
- T3 25% 5 years survival
- RT = incomplete response or local recurrence in 50% of patients - further treatment is likely
9
Q
Who will have surgery as a management option?
A
- Excision of bladder tumours
- Whole bladder could also be removed
- Used for low grade or single papillary tumours, NMIBC
10
Q
Who gets a radical cystectomy?
A
- Large T1, T2 and T3 tumours CIS
- Males = removal of prostate and seminal vesicles
- Females = removal of uterus and vaginal cuff
- Complications, UTI, stenosis or obstruction
- impotence, fistulae, infection, small bowel obstruction small mortality rate.
11
Q
How are recurrent low grade tumours managed?
A
- Thermocoagulation
- Photodynamic therapy (where the tumour shows up red under blue light)
12
Q
How are high grade or muscular invading tumour managed?
A
- Electrocautery
- Local anaesthetic
- Tissue is destroyed by burning with an electric spark, uses 5-amino lavelic acid and tumour glows red under a blue light
13
Q
When is intravesical chemotherapy used?
A
- For high grade NMIBC
- Used prophylactically or adjuvantly. (to prevent recurrence)
- Used post-op for small recurrences
- Mitomycin C, Epirubicin, Thiotepa, doxorubcin
- adv = high local exposure with minimal systemic toxicity
- disav = local bladder toxicity, unpleasant, invasive.
14
Q
When is neoadjuvant chemo used?
A
- IV: cisplatin, methotrexate and vinblastine in three cycles
- RT or surgery follows
15
Q
When is adjuvant chemo used?
A
- For recurrent or advanced disease
- Increases complete remission rates
- Little evidence for long-term survival
