Haematuria Flashcards
What is the most common histological subtype of bladder cancer in the UK?
transitional cell carcinoma
What are the 2 week wait criteria for bladder cancer?
aged 45 and over and have:
unexplained visible haematuria without urinary tract infection or
visible haematuria that persists or recurs after successful treatment of urinary tract infection, or
aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.
Which of the following is not a common investigation in haematuria
flexible cystoscopy CT urogram USS KUB MRI pelvis urine cytology?
MRI pelvis
What is the definition of staging in cancer?
how far the cancer has spread from its original site
What is the definition of grading in cancer?
how well-differentiated the cancer is
Which of the following is a risk factor for the development of bladder cancer:
female sex low BMI smoking malaria black ethnicity?
smoking
also male sex high BMI schistosomiasis caucasian
A 45 year old male presenting with flank pain, nausea and non-visible haematuria. What is the most likely diagnosis?
kidney stones
What is the gold standard imaging for kidney stones?
CT KUB
How should clot retention be managed?
bladder washout
3 way catheter
irrigation
Which of the following describes muscle invasive bladder cancer:
invasion of the lamina propria G2 Transitional cell carcinoma T2 Transitional cell carcinoma profound haematuria Solid looking tumour on cystoscopy?
T2 Transitional cell carcinoma
Why is squamous cell carcinoma more common in Egypt?
schistosomiasis
What risk is a transitional cell CIS?
high risk
Why is visible haematuria worrying?
it has a high positive predictive value for urological malignancy
Which sites can haematuria come from?
kidney ureter bladder prostate urethra other
What groups of aetiology cause haematuria?
MIST(e)
malignancy infection stones trauma extra
How does most kidney cancer present?
incidentally
What does bladder cancer most commonly present with?
haematuria
Give causes of pseudohaematuria?
menses
beetroot
rhabdomyolysis
What does urine cytology look for?
malignant cells in the urine
What bed side tests can be performed for haematuria?
observations
blood glucose
urinalysis
urine cytology
What blood tests can be performed for haematuria? What do they look for?
FBC for anaemia or infection Us+Es LFTs for liver mets uric acid and bone profiling for stones clotting for a bleeding disorder
What imaging is done to investigate haematuria?
1st line is US KUB
CT urogram
CT thorax for lung cancer
How can emergency haematuria present?
anaemia
shock
clot retention
What is the gender distribution of bladder cancer?
3 males: 1 female
Give congenital risk factors for developing bladder cancer
increasing Asian
Caucasian ethnicity
positive family history
male sex
Give acquired risk factors for developing bladder cancer
smoking occupational (hair dresser, rubber, dyes) medications (cyclophosphamide) chronic inflammation (stones, catheters, schistosomiasis) radiation Crohn's disease renal transplant (immunosuppression) increased BMI
Give symptoms of bladder cancer
haematuria recurrent UTI LUTS non-specific eg. weight loss, fatigue... palpable mass
In TNM staging of bladder cancer, what is
a) Ta?
b) T1?
a) non invasive
b) invades lamina propria
What percentage of transitional cell carcinomas are non muscle invasive?
80%
How is non invasive bladder cancer manage?
transurethral resection (TURBT) intravesical chemo w mitomycin
How is invasive bladder cancer managed?
cystectomy
chemo + radio
Bilaterally enlarged kidneys, flank pain + haematuria suggests what?
autosomal dominant polycystic kidney disease
