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Skin Radiation therapy > Bladder urethra cancer > Flashcards

Bladder urethra cancer Flashcards

1
Q 
the ureters enter the bladder through the \_\_\_\_wall of the bladder.
A.superior
B.inferior
C.anterior
D.posterior
A

D

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2
Q 
the bladder is posterior to the:
A.ilium
B. pubis bone
C.Sacrum
D.orbutrator foramen
A

B

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3
Q 
the lymphatics of the bladder include:
A. Internal iliac 
B. paraaortic 
C. external iliac
D. common iliac
E. inguinal Ln
A

A,C,D

**the bladder also drains to the pelvic LN

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4
Q

which is true regarding the epidemiology of bladder cancer?
A. more common in F than M
B. more common in M than F
C. 4th most common cancer in M
D. more likely to occur in younger patients

A

B

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5
Q 
Primary symptom of bladder cancer?
A.painless hematuria
B.flank pain
C.palpable abdominal mass
D.urinary tract infection
A

A

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6
Q 
most common histology of bladder cancer is:
A.. adenocarcinoma
B.SCC
C. transitional cell carcinoma
D. clear cell carcinoma
A

C

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7
Q 
The most common site within the bladder for cancer is:
A. Base
B.trigone
C.aoex
d.posterior wall
A

B

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8
Q 
what is true regarding EBRT to the bladder?
A.commonly used with Cx
B.4 field beam arrangement
C. preferred modality of treatment
D.Treat GTV to 65-70Gy
E.superior border is T10
A

A,B,D

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9
Q 
in order to - toxicity to normal structures you would instruct the patient to \_\_\_\_\_ during their boost treatment for bladder cancer
A. fill their bladder
B. empty their bladder
C. fill their rectum
D. empty their rectum
A

A

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10
Q

bladder cancer is _ most common cancer in men and _ most common cancer in women

A

4th, 8th

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11
Q

cancer incidence M:F :

A

4:1

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12
Q

Chemicals that increase the risk of bladder cancer

A

Bensidine, Naphthylamine (arylamines)

  • Cyclophosphamide
  • Hair dyes
  • Coffee/Artificial sweetener
  • Diesel exhaust
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13
Q

things that + risk of bladder cancer

A

smoking, chronic UTI’s, chemical exposures, previous XRT and Schistosomiasis haematobium (related to SCC)

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14
Q

in men what structure separates the upper part of the bladder and the rectum
what does it separate in women

A

the retrovesical pouch

separates the bladder from the uterus in women

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15
Q

what separates the lower part of the apex of the bladder from the rectum in men

A

the seminal vesicles and the deferent duct

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16
Q

shape of the bladder when empty

A

tetrahedral

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17
Q

the apex of the bladder is connected to the umbilicus by____

A

middle umbilical ligament

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18
Q

the sigmoid colon and the small intestine lies ____

bladder

A

superior

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19
Q

3 layers of the bladder

A

Transitional epithelium (aka urothelium) + Lamina Propria
Muscularis Propria
Perivesical fat + peritoneum

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20
Q

length of the bladder trigone

A

contracted =2.5cm

distanede =5cm

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21
Q

in men the bladder neck rests on the _____.

A

prostate

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22
Q

whats the bladder trigone?

A

(the triangular portion of the bladder formed by the opening of the ureters and urethra orifice

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23
Q

what type of tissue is mostly involved in bladder cancer?

A

epithelial tissue

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24
Q

tumour progression

A

The most common areas affected are the lateral walls and the bladder dome. Can also spread locally into the urethra, prostate, upper vagina, and rectum. Often spread out through the bladder and not always confined to one area. Some patients may present with a lesion on the ant and post sides

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25
Q

bladder cancer is usually presented _____.

A

early

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26
Q

Distant mets in bladder cancer

A

lung liver and bone

27
Q

most common presentation in bladder cancer

A

painless hematuria

28
Q

clinical presentation of bladder cancer

A

Painless haematuria
Urinary irritation (frequency, urgency, dysuria)
Urinary retention
Frequent infections

29
Q

pathologies of bladder cancer

A

a) Transitional Cell Carcinoma (92%)
b) SCC (6%)
c) Adenocarcinoma (2%)

30
Q

4 morphologies of bladder cancer

A

Papillary (70%)
Papillary Infiltrating
Solid Infiltrating
Non-papillary, non-infiltrating or carcinoma in situ

31
Q

staging system for bladder cancer

A 
TNM
Superficial 75-85%
T0-non invasive papillary
Tis-flat carcinoma non-invasive
T1-invades lamina proper

invasive 15-25%
T2- invades muscle
T3-invades perivesical tissue
T4-invades surrounding organs

32
Q

regional LN spread

A

internal and external iliac and pre sacral Ln

33
Q

what spread is common after the tumour has invaded muscle

A

Perineural invasion and lymphatic or blood vessel invasion

34
Q

LN drainage

A

The bladder including the trigone drains to the internal iliac nodes, however; there is the possibility of spread to the obturator nodes and the external iliac nodes. From these nodes, they progress to the common iliac and paraaortic lymph nodes.

35
Q

rationale for surgery

A

Used as a PRIMARY treatment for Superficial disease and Stage III Invasive disease(if partial or no response to chemo)
Also used to salvage recurrences after radical RT

36
Q

gold standard surgery for bladder cancer

A

radical cystectomy

37
Q

radical cystectomy procedure for men vs women

A

in men it removes the bladder, prostate and the seminal vesicles
in women it removes bladder, upper vagina, uterus, cervix fallopian tube and ovaries
the urethra is removed in both women and men with high risk disease

38
Q

ileal conduit procedure

A

Take out the bowel, use as a hose. Run the hose to the skin and hook up ureters to the end of the hose

39
Q

Indiana pouch procedure

A

Make an internal pouch. The patient has to drain it several times a day and it is prone to infections but its better than a bag

40
Q

palliative surgery

A

resections are not used for bulky disease

these patients might use ill conduit for patients with inflamed and irritated badder

41
Q

indications XRT

A

Used as a PRIMARY treatment for Stage II Invasive disease or Stage III invasive if complete response to chemotherapy

42
Q

Phases of XRT

A

PHASE I
40/20 to the bladder +/- pelvic LNs

PHASE II
20/10 to a smaller volume

43
Q

Indications chemotherapy

A

Used NEOADJUVANTLY in Stage III Invasive disease to debulk
Used as a PRIMARY CONCURRENT treatment with XRT in Stage IV Invasive disease
Used as an ADJUVANT treatment in Superficial disease and Stage II Invasive disease

44
Q

chemo agent

A

cisplatinum

45
Q

stage 1 bladder cancer treatmenr

A

Primary: Surgery (TURBT)

Adjuvant: BCG(immunotherapy) or Intravesical Chemotherapy (directly into bladder)

46
Q

stage 2 bladder cancer treatment

A

STAGE II
Primary: Radical Cystectomy OR XRT with concurrent cisplatin (if organ present or unfit for surgery)
Adjuvant: Chemotherapy (high risk or node positive)

47
Q

stage 3 bladder cancer treatment

A

Neoadjuvant: Chemotherapy (Debulk)
Primary: If complete response to chemo → Chemorads
If partial or no response to chemo → Surgery (Radical Cystectomy)

48
Q

stage 4 bladder cancer treatment

A

Primary: Chemotherapy

49
Q

scan limits of bladder cancer

A

Sup Border : L3-L4
Inf Border: 5cm inf of ischial tuberosities

50
Q

field borders for bladder cancer

A

Sup: L5/S1 (if having concurrent chemo) OR L4/L5 to include common iliac nodes
Inf: Bottom of obturator foramen
Lat: 1.5-2.0cm beyond widest extent of pelvic brim
Ant: 1.0-1.5 cm ant to symphysis pubis which includes the bladder with a 1.5 cm margin
Post: 2.0-2.5 cm post to visualized bladder

51
Q

shielding for bladder cancer

A 
AP/PA FIELD (4 CORNERS)
         	SUP corners: Small bowel
         	INF corners: femoral head and neck
   	LAT FIELD
        	Small bowel, rectum, anal canal
52
Q

dose for bladder cancer

A

Whole Pelvis – 40/20 (4 weeks)
Bladder Boost – 20/10 (2 weeks)

TOTAL – 60/30 (6 weeks) 200 cGy per day

53
Q

target volume of bladder XRT

A

Entire Bladder

Internal and External Iliac nodes

54
Q

where does the bladder lie when empty?

A

in the true pelvis

55
Q

what subtype of bladder cancer remains superficial which is more invasive?

A

papillary tumours are superficial and solid lesions are usually invasive

56
Q

diagnostic methods bladder cancer

A

CBC, liver function, urine analysis, urine cytology, Biopsies of bladder and urethra, IVpyelogram, CT or MRI of pelvis and abdomen pelvic/rectal exam

57
Q

staging systems in bladder cancer

A

marshall staging and TNM of the AJCC system

58
Q

most common morphological subtype of bladder cancer

A

papillary

59
Q

Marshall system of classification

A

A- = T1 of AJCC- tumour invades sub epithelia connective tissue
B1- =T2a of AJCC-tumour invades superficial muscular proper
B2-T2b of AJCC tumour invades deep muscular propirA
C-T3 of AJCC tumour invades perivesical tissue
D1- T4 of AJCC tumour invades uterus, vagina, pelvic wall, abdominal wall or prostatic stroma

60
Q

dose of XRT alone

A

64-68Gy

61
Q

what % of bladder ca are associated with smoking ?

A

50-80 %

62
Q

what % bladder ca are associated with occupatial exposures

A

20%

63
Q

latency period from occupational exposure to bladder cancer?

A

15 years

Skin Radiation therapy (40 decks)

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