The Urinary system - bladder

Question 1

epidemiology and aetiology of bladder cancer?

Answer 1

male:female 5:2
2/3 caused by cigarette smoking
occupational exposure to carcinogenic chemicals
arsenic exposure
prior RT to pelvis

Question 2

what sysmptoms do bladder cancer patients present with

Answer 2

increased urgency and frequency
haematuria (blood in urine)
pelvis pain

Question 3

what diagnostic and staging tools are used?

Answer 3

diagnostic - urinalyses, cystoscopy, biopsy, blood test

staging- CT, MRI, bone scan, chest x-ray, liver funstion tests

Question 4

what are the 3 tissue layers of the bladder?

Answer 4

Mucaso - squamous cell epithelium lines the bladder, ureters & urethra
muscularis
connective tissue -

Question 5

what is the main type of tumour in bladder cancer?

Answer 5

urothelial carcinoma

others; SCC, adenocarcinoma

Question 6

describe the staging; Ta, T2b & T4a for bladder cancer?

Answer 6

Tis-T1 - noninvasive
Ta ,T1- epithelium only - superficial
T2b - deep muscle invasion - invasive tumours
T4a - prostate or vagina invasion

Question 7

what grading system is used?

Answer 7

WHO grading systme
well differentiated - low grade
poorly differentiated - high grade

Question 8

what lymph nodes surround the bladder ?

Answer 8

vesical lymph nodes surround the bladder
obturator, external, inetrnal and common iliac nodes (N3)
further spread via para aortic and inguinal nodes

Question 9

what treatment options are used?

Answer 9

Ta - T1 - surgery + adjuvant chemo or BCG
T2-T4 - radical surgery + lymph node dissection
Radical RT
neo-adjuvant chemotherapy (invasive)
may need bladder reconstruction after surgey

Question 10

2 disadvantages and 2 advantages of cisplatin based neo-chemo for bladder cancer?

Answer 10

adv - more tolerated before cytectomy, 5-8% survival adv,

dis - delays the primary treatment, may not have any microspread

Question 11

what surgery options are used for bladder cancer?

Answer 11

removal of pelvic lymph nodes

cytectomy to remove part or all of the bladder (urine is re-diverted, continent or incontinent diversion)

Question 12

when is RT used?

Answer 12

T2 = T3
if inoperable or patient prefrence
salvage cystectomy can be used
T4B - palliative RT to pelvis

Question 13

main issue of treating bladder cancer with RT?

Answer 13

organ motion & replicability, may use bladder or rectal filling

Question 14

what are the orgabs at risk?

Answer 14

rectum, vagina, prostate, femoral heads, small bowel

Question 15

what is the beam arragement and dose for bladder cancer?

Answer 15

3DCRT 3 field (ant 2 post obliques or 2 lateral)
64Gy in 32# 6.5 weeks 6-10Mv
2 phase - 44Gy in 22# to whole pelvis
boost - 20Gy in 10# to bladder 
palliative - 35Gy in 10# or 21Gy in 3#

Question 16

side effects of RT for bladder cancer?

Answer 16

common after 30-40Gy
cystitis
haematuria
increased frequency and arguency 
diarrhoea
fatigue 
skin reactions