renal and bladder cancer Flashcards
what are the types of bladder cancer?
- transitional cell carcinoma (most common, 80-90% cases)
- squamous cell carcinoma (SCC)
- adenocarcinoma (rare), and sarcoma (rare).
what are RF’s for Bladder CA ?
- 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
how does Bladder CA present?
painless haematuria Recurrent UTIs LUTS - frequency, uregency, incomplete voiding features of obstruction local features - pelvic pain systemic features
how is bladder cancer investigated?
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.
how is bladder cancer staged ?
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
how is bladder cancer treated based on stage ?
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)