Bladder Tumours

Question 1

Epidemiology of Bladder tumours?

Answer 1

M>F 4:1

Question 2

What are the most common types of Bladder tumours?

Answer 2

TCC= 90%
SCCs associated with schisto
Adenocarcinoma least

Question 3

Natural Hx of Bladder tumours?

Answer 3

Low grade: non invasive, high rate of recurrance

High grade: 20% invasive and high recurrance

Question 4

Risk factors for Bladder tumours?

Answer 4

Smoking
Amine exposure (rubber)
Previous renal TCC
Chronic cystitis
schisto (scc)
Urechal reminants (adeno) 
Pelvic irradiation

Question 5

Presentation of Bladder tumours?

Answer 5

PAINLESS HAEMATURIA
Voiding irritability: dysuria, frequency, urgency
recurrent uti
retention/obstructive renal failure

Question 6

What may you find on examination?

Answer 6

Anaemia
Palpable bladder mass
palpable liver

Question 7

TNM?

Answer 7

1=lamina propria
2=superficial muscle
3= deep muscle
4-invasive other structure

Question 8

where do Bladder tumours spread?

Answer 8

Pelvic structures
iliac and paraaortic nodes
bones liver and lungs

Question 9

Ix for Bladder tumours?

Answer 9

urine dip: sterile pyuria, cytology

CYSTOSCOPY is diagnostic

CT/MRI helps stage

Question 10

Management?

Answer 10

Depends on grade and spread

up to T1: Diathermy, TURBT, mitromycin, BCG

t2/3: Radical cystectomy with ilial conduit
Radiotherapy has a worse 5ys but preseves bladder- salvage cystectomy is possible
Adjuvant chemo

t4- palliative

Question 11

Complications of Bladder tumours?

Answer 11

Massive bladder haemorrhage

Cystectomy-> urinary and sexual malfx

Question 12

follow up for Bladder tumours?

Answer 12

70% recur so intensive follow up required, hx ex and regular cystoscopy