renal and bladder cancer Flashcards

1
Q

what are the types of bladder cancer?

A
  • transitional cell carcinoma (most common, 80-90% cases)
  • squamous cell carcinoma (SCC)
  • adenocarcinoma (rare), and sarcoma (rare).
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2
Q

what are RF’s for Bladder CA ?

A
  • Smoking
  • Aromatic compound exposure e.g dye and rubber industries
  • Previous radiation exposure (e.g for prostatic cancer)
  • T2DM
  • Recurrent UTIs
  • Schistosomiasis infection (only causes SCC)
  • Long term catheter
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3
Q

how does Bladder CA present?

A
painless haematuria 
Recurrent UTIs
LUTS - frequency, uregency, incomplete voiding 
features of obstruction 
local features - pelvic pain 
systemic features
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4
Q

how is bladder cancer investigated?

A

Urinalysis = haematuria

Urine cytology = May reveal malignant cells; if there are malignant cells, TCC or carcinoma in situ will probably be present.

Cystoscopy = Images the bladder and urethra; suspect lesions usually require transurethral resection under GA for diagnosis.

Transurethral resection of Bladder Tumour (TURBT)

Upper tract imaging = Used to identify and assess pelviureteric tumours.

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5
Q

how is bladder cancer staged ?

A

Tis – in-situ (i.e. Not crossed basement membrane)
Ta – confined to epithelium
T1 – crosses LP (epithelium + LP = mucosa)
T2 – superficial muscle involvement
T3 – deep muscle involvement
T4 – invasion beyond bladder

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6
Q

how is bladder cancer treated based on stage ?

A

Ta to T1 (Non-muscle invasive): TURBT +/- 6 week course of intravesical mitomycin C (reduces risk of recurrence). If high grade may also receive BCG

T2 to T3: radical cystectomy plus urinary diversion (typically an ileal conduit)

T4: palliative chemo/RT
Follow Up – regular check cystoscopy (70% recur)

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