(U)- Bladder Cancer Flashcards

1
Q

Where does cancer in the bladder arise from?

A

Urothelium (endothelial lining)

Majority are superficial, non-invasive

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

What are the risk factors of bladder cancer?

A

Aromatic amines-dye and rubber industry
Smoking
Schistosomiasis (squamous cell carcinoma)

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

How common are different types of bladder cancer?

A

Transitional cell carcinoma
90%

Squamous cell carcinoma
5% (higher in areas with schistosomiasis)

Adenocarcinoma
2%

Sarcoma and small-cell carcinoma

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

What is the key symptom of bladder cancer?

A

Painless haematuria

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

What does NICE recommend when managing patients presenting with bladder cancer?

A

Two week wait referral for:

  • Over 45 with unexplained visible haematuria, without a UTI or persisting after treatment for a UTI
  • Over 60 with microscopic haematuria and
  • Dysuria or raised WBC on FBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is bladder cancer diagnosed?

A

Cystoscopy

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

What does non-muscle-invasive bladder cancer include?

A

Tis Carcinoma in situ, cancer cells only affect urothelium and are flat

Ta Cancer only affecting urothelium and projecting into bladder

T1 Cancer invading connective tissue layer beyond urothelium but not muscle layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does invasive bladder cancer include?

A

T2-4 and any lymph node or metastatic spread

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

What treatment options are available for bladder cancer?

A

Transurethral resection of bladder tumour
Non-muscle-invasive bladder cancer
Removing the bladder tumour

Intravesical chemotherapy
Chemotherapy given directly into bladder, often after TURBT

Intravesical Bacillus Calmette-Guérin
BCG vaccine into bladder stimulates immune system to attack bladder tumours

Radical cystectomy
Removal of entire bladder

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

After radical cystectomy, how is urine drained?

A

Urostomy with ileal conduit
Most common

Continent urinary diversion
Neobladder reconstruction
Ureterosigmoidostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a urostomy?

A

Used to drain urine by creating an ileal conduit

15-20cm of ileum is removed, bowel is reconnected

Ureters are anastomosed to section of ileum, other end of the ileum forms a stoma on the skin draining urine into a urostomy bag

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

What is a continent urinary diversion?

A

Pouch created inside the abdomen from section of ileum, ureters are connected

Pouch fills with urine

Thin tube connected between stoma on the skin and internal pouch

Catheter needs to be inserted into stoma to drain urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a neobladder reconstruction?

A

New bladder created from section of ileum

Connected to both ureters and urethra

Functions similarly to normal bladder

May require catheterisation and bladder washouts to clear small bowel secretions

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

What is a ureterosigmoidostomy?

A

Ureters directly attached to sigmoid colon

Urine drains and collects in sigmoid

Rectum can be expanded to create a recto-sigmoid pouch (Mainz II procedure) for more space for urine to collect

Urine drained in same way bowels are opened

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

Why is ureterosigmoidostomy used rarely?

A

Associated with:

  • Kidney infection
  • Electrolyte imbalance
  • Secondary cancer at anastomosis between ureters and sigmoid colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly