Transitional Cancers

Question 1

What is Transitional Cell Cancer

Answer 1

Arises in the renal pelvis, ureters or the Bladder.

Question 2

Incidence of TCC

Answer 2

Most common in males 4:1,
In UK 1:6000
Common in elderly >50, mean age 70’s.

Question 3

Risk Factors for TCC

Answer 3

Male, Age, Caucasian
Smoking is the major RF
Chronic UTIs/stones or catheters
Pelvic radiation
Cyclophosphamide
Exposure to carcinogens in Paint/petrochemicals/plumbers
Occupational exposure

Question 4

Clinical Features of TCC

Answer 4

Painless Frank Haematuria = Bladder Ca until otherwise proven.

Obstruction - outflow= nocturia, frequency, polyuria, urgency
Renal obstruction = hydronephrosis = renal failure

Systemic features: weight loss, fatigue, abdominal pain, fullness, anorexia

Question 5

Investigations for TCC

Answer 5

Bloods: FBC, U+Es checking kidney function, LFTs, CRP/ESR, Calcium, Glucose,

Urine dip and analysis: Blood +++

Question 6

Imaging for TCC

Answer 6

Renal USS - detect renal involvement or hydropnephrosis
Flexible cystoscopy moving to rigid cystoscopy if lesion present for biopsy.

CT staging used or CT IVU for blockage of GU

Question 7

Treatment of TCC

Answer 7

TURB in low grade - removal of lesion and treatment with mitomycin for 6weeks intravesically.

T2-3= Radical Cystectomy. with ileo conduit or neobladder made.

Radiotherapy can be used to retain bladder or if unsuitable for operation.
Post op chemotherapy used.

T4 - palliative Chemotherapy- (MVAC) and Radiotherapy used.

T1c - serious as high invasion risk (50%), intravesicle BCG used to induce immune reaction. 6 week course.

Question 8

Prognosis

Answer 8

poor if T4 with nodal spread.