transitional cell carcinoma

Question 1

what urological organs does transitional epithelium line

Answer 1

1. urinary tract lining
2. renal pelvis
3. ureter
4. bladder
5. urethra (up to fossa navicularis in men)

Question 2

what should be suspected if painless haematuria is present

Answer 2

cancer until proven otherwise

Question 3

risk factors for bladder cancer

Answer 3

1. age
2. sex (male)
3. smoking
4. occupational exposure - rubber/dye manufacture, hairdressers, chemicals, plumbers, painters, drivers (diesel exhuast)
5. drugs - cyclophosphamide
6. chronic irritation - stones, catheter etc.
7. pelvic radiotherapy

Question 4

bladder TCC presentation (4)

Answer 4

1. haematuria
2. LUTS
3. recurrent UTI
4. others e.g. pneumaturia, pain, lower limb swelling, bone pain, anuria

Question 5

superficial bladder TCC mgx

Answer 5

Trans urethral resection of bladder tumour (TURBT)

Question 6

T stages for bladder cancer

Answer 6

Ta - non invasive papillary
Tis - Tumour in situ (change in epithelial lining)
T1 - subepithelial connective tissue
T2 - invasion of muscularis
T3 - invasion beyond the muscularis
T4 - invasion of surrouding structures e.g. prostate, uterus, vagina

Question 7

what can be done for urinary diversion post bladder removal

Answer 7

1. ileal conduit
2. orthotopic neobladder
3. continent pouch
4. ureterosigmoidostomy

Question 8

what is an ileal conduit

Answer 8

diversion of urine to a newly formed opening on the skin through a peice of ileum that has been removed -> urine then collected in a bag

Question 9

what is an orthotopic neobladder

Answer 9

the creation of a new bladder -> it can be ileal, ileo-colic or colonic (part of the intestine is used to create it)

Question 10

what is a ureterosigmoidostomy

Answer 10

a surgery that connects the ureters to the sigmoid colon and allows urine to pass out of the body that way

Question 11

why are ureterosigmoidostomies not performed that much anymore

Answer 11

high risk of problems incl. tumour formation at the sigmoid anastamosis

Question 12

what information can IVU provide about the renal pelvis

Answer 12

presence of filling defects

Question 13

where are the majority of TCC cancer found

Answer 13

the bladder

Question 14

where can an upper tract (i.e. renal pelvis) TCC spread to (what structures)

Answer 14

1. direct extension - renal vein and vena cava
2. lymphatic spread - para aortic, para caval, pelvic
3. haematoganous spread - liver, lung, bones

Question 15

2 curative treatments for TCC

Answer 15

1. nephro ureterectomy (kidney + ureter up to bladder)
2. uretero-renoscopic laser ablation

Question 16

3 palliative mgx for TCC

Answer 16

1. systemic chemotheraoy
2. palliative surgery (kidney removal)
3. arterial embolisation