FN: Bladder Tumours Flashcards
Bladder Tumours epi
Incidence:1:5000/yr
Sex: M>F = 4:1
Bladder Tumours Pathology
Transitional cell carcinomas account for 90%
SCCs: association with schistosomiasis
Adenocarcinoma
Bladder Tumours Natural Hx Low-grade Tumours
80%
Non-invasive, generally not life-threatening
High rate of recurrence
Bladder Tumours High-grade tumours
20% invasive and life-threatening
High recurrence rates
Bladder Tumours RF
Smoking Amine exposure (rubber industry) Previous renal TCC Chronic cystitis Schistomiasis (SCC) Urechal remnants (adenocarcinoma) - embryological remnant of communication between umbilicus and bladder Pelvic irradiation
Bladder Tumours PResentation
Painless haematuria
Voiding irritability: dysuria, freqeuncy, uregency
REcurrent UTIs
Retention and obstructive renal failure
Bladder Tumours examination
Anaemia
Palpable bladder mass
Palpable liver
TNM staging
80% confined to mucosa
20% penetrate muscle (raised mortality)
Spread
Local - pelvic structures
Lymph - iliac and para-aortic nodes
Haem - bones, liver and lungs
Histological classification
Grade 1: well differentiated
Grade 2: intermediate
Grade 3: poorly differentiated
Investigations
Urine: dip (sterile pyuria), cytology IVU: filling defects Cystoscopy with biopsy: diagnostic Bimanual EUA: helps to assess spread CT/MRI: helps stage
Mx
Depends on histological grade and the presence of dissemination
Tis, Ta and T1 (superficial)
- 80% of all pts.
- Diathermy via transurethral cystoscopy/TRansurethral resection of bladder tumour
- Itravesicular chemo: mitomycin C
- Intravesicular immunotherapy: BAcille Calmette-Guerin
T2, T3 (Invasive)
- Radical cystectomy with ileal conduit is gold standard
- Radiotherpy: worse yrs but preserves bladder - salvage cystectomy can be performed
- Adjuvant chemo e.g. M-VAC
- Neoadjuvant chemo may have a role
t4 Mx
Palliative chemo/radiotherapy
Long-term cathererisation
Urinary diversions
