Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urinary System > Tumours of the Urinary System - Bladder Cancer > Flashcards

Tumours of the Urinary System - Bladder Cancer Flashcards

1
Q

What is urothelial cancer?

A

Malignant tumours of transitional epithelium (urothelium):
• Bladder
• Upper tract (i.e. ureter, renal pelvic and collect system) –> UTUC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the pathology of bladder cancer

A

The tumour type is most often transitional cell carcinoma (i.e. 90% in UK)

Where Schistosomiasis is endemic, squamous cell carcinoma of the bladder is the common tumour type.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors for TCC bladder cancer?

A
  • Smoking (accounts for 40% of cases)
  • Aromatic amines
  • Non-hereditary genetic abnormalities (e.g. TSG incl. p53 and Rb)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the different types of bladder cancer?

A
  • TCC
  • Squamous cell carcinoma
  • Adenocarcnoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors for Squamous cell carcinoma bladder cancer?

A
  • Shistosomiasis (S. haematobium only)
  • Chronic cystitis (e.g. recurrent UTI, long term catheter, bladder stone)
  • Cyclophosphamide therapy
  • Pelvic radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors for adenocarcinoma bladder cancer?

A

Common for urachal cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does a bladder cancer typically present?

A
  1. Painless visible haematuria
  • Symptoms due to invasive or metastatic disease
  • Haematuria may be frank (reported by patient) or microscopic (detected by doctor)
  1. Recurrent UTI
  2. Storage bladder symptoms:
    • Dysuria, frequency, noctuira, urgency +/- incontinence
    • Bladder pain
    • If present, suspect CIS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does CIS stand for?

A

Carcinoma in situ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What investigations are carried out for the haematuria in bladder cancer?

A
  • Urine culture (shows UTI)
  • Cystourethroscopy
  • Upper tract imaging: CT urogram (IVU), USS
  • Urine cytology (see if cells are malignant - differentiate CIS from red, inflamed bladder)

• BP and U+Es

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How in frank haematuria investigation?

A
  • > 50yrs - risk of malignancy (25-35%)
  • Flexible cystourethroscopy within 2 weeks
  • IVU + USS
  • CT urogram
  • Urine cytology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an IVU?

A

Intravenous urogram is an x-ray exam that uses an injection of contrast material to evaluate your kidneys, ureters and bladder and help diagnose blood in the urine or pain in your side or lower back.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Wha investigations are used for microscopic haematuria?

A
  • > 50yrs - risk of malignancy 5-10%
  • Flexible cystourethroscopy within 4-6weeks
  • USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are diagnostic test for urothelial tumours?

A
  • Cystoscopy and endoscopic resection (TURBT) - biopsy
  • EUA to assess bladder mass/thickening before and after TURBT

• Fluorescent cystoscopy to highlight areas of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why can’t IVU tests diagnosis urothelial tumours?

A

Alone it will miss a proportion of renal cell tumours (especially if <3cm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why can’t USS tests diagnosis urothelial tumours?

A

Alone will miss a proportion of urothelial tumours of the upper tracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What tests are used for staging (T, N, M) of urothelial tumours?

A
  • Cross-sectional imaging (CT, MRI)
  • Bone scan if symptomatic
  • CT Urogram for upper tract TCC
17
Q

What is the test can be used for treatment of urothelial tumours?

A

Endoscopic or radical

18
Q

What classification is used to grade bladder tumours?

A

TNM classification

19
Q

Describe T stage of bladder tumours

A
  • Non-muscle invasive (superficial)

* Muscle invasive (invade detrusor muscle)

20
Q

What are the different grades of TCC?

A

G1 = Well diff. - commonly non-invasive
G2 = Mod. diff. - often non-invasive
G3 = Poorly diff. - often invasive
Carcinoma in situ (CIS) – non-muscle invasive but VERY aggressive (hence treated differently)

21
Q

What is the treatment of a low-grade non-muscle invasive (Ta or T1) TCC?

A
  • Endoscopic resection followed by single instillation of intravesical (into bladder) chemotherapy (mitomycin C) within 24 hours
  • Prolonged endoscopic follow up for moderate grade tumours
  • Consider prolonged course of intravesical chemotherapy (6 weeks months) for repeated recurrences
22
Q

What is the treatment for high-grade non-muscle invasive bladder cancer or CIS?

A
  • Very aggressive – 50-80% risk of progression to muscle invasive stage
  • Endoscopic resection alone not sufficient
  • CIS consider intravesical BCG therapy (maintenance course, weekly for 3 weeks repeated 6 monthly over 3 years) - induce immune response
  • Patients refractory to BCG – need radical surgery
23
Q

What is the treatment for muscle invasive bladder cancer (T2-3)?

A

• Neoadjuvant chemotherapy for local and systemic control

Followed by either:
• Radical radiotherapy and/or;
• Radical cystoprostatectomy (men) or anterior pelvic exenteration with urethrectomy (women); with extended lymphadenectomy
• Radical surgery combined with incontinent urinary diversion (i.e. ileal conduit), continent diversion (e.g. bowel pouch with catheterisable stoma) or orthotopic bladder substitution

24
Q

What is the prognosis of bladder cancer dependent on?

A
  • Stage
  • Grade
  • Size
  • Multifocality
  • Presence of concurrent cis
  • Recurrent at 3 months
25
Q

What does UTUC stand for?

A

Upper tract urothelial cancer (or called upper tract TCC)

26
Q

What does UTUC typically present with?

A
  • Frank haematuria
  • Unilateral ureteric obstruction
  • Flank or loin pain
Symptoms of nodal or metastatic disease:
• Bone pain 
• Hypercalcaemia 
• Lung 
• Brain
27
Q

What investigations should be used for UTUC?

A
  • CT-IVU or IVU
  • Urine cytology
  • Ureteroscopy
28
Q

What can IVU/CT-IVU show in UTUC?

A

Filling defect in renal pelvis

29
Q

Where in the urinary tract are upper tract TCC most likely to arise?

A
  • Renal pelvis or collecting system commonest

* Ureter less common

30
Q

What are most upper tract TCCs treated by?

A

Nephro-ureterectomy (removal of renal pelvis, kidney, ureter, and bladder cuff)

31
Q

Why are Nephro-ureterectomy treatment of choice for UTUC?

A
  • Tumours are often high-grade and multifocal on one side
  • High risk of local recurrence if treated endoscopically or by segmental resection
  • Low risk of having contralateral disease
  • Difficult to follow up if treated endoscopically
32
Q

What are other treatment options for UTUC other than nephron-ureterectomy?

A
  • If unfit for nephro-ureterectomy, or bilateral disease –> nephron-sparing endoscopic treatment
  • If univocal and low-grade disease –> endoscopic treatment
33
Q

What do all cases of bladder TCC require after treatment?

A

Surveillance cystoscopy

Urinary System (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions