Urinary Bladder Flashcards
epidemiology
2.6:1 (M:F)
rare in under 50s, 2/3 are 65+
twice more likely in caucasians
11th most common
10 year survival
aetiology
exposure to chemical carcinogens (2-naphthylamine and benzidine)
diet: high fats and coffee
genetics
smoking (6x more common)
drugs
radiation: previous RT, radioactive iodine filtered by kidneys, radiation disasters
chronic irritation: UTI’s schistous, higher risk of SCC in bladder, bladder stones, catheters
what cell is the tumour
transitional cell carcinoma
investigations
full medical history: etiological factors, previous symptoms
cystoscopy: biopsy around the bladder, indicate size and extent, relays images to the computer
radiography: plain chest x-ray to rule out mets, IVU: in the bladder or elsewhere, CT: extravesical spread [outside bladder wall]
haematological: U&E, FBC, LFT
urine analysis: cytology, excess glucose, blood pus cells or bacteria [60% of tumour cells can be identified]
presentation
painless haematuria
urgency
frequency
dysuria
reduction in urine stream
pain: outside bladder
obstruction = renal failure
what are met symptoms
pathological fracture
no function in legs
pain up and down legs
impact on urinary function
difficulty breathing
haemopytsis
SOB
what is the Macro pathology
80% papillary
12% will be invasive
appearance of solid invasive
looks nodular and ulcerated, which is rapidly growing invading through the bladder wall, increases met spread through lymphatics
what is the micro pathology
TCC = 90%
SCC incidences are high when there is schistomiasis present
adenocarcinomas are rare
sarcomas, lymphomas, small cell and melanomas are very rare
treatment for superficial
dependent on the cancer type
recurrence rate is 60%
active surveillance is needed
what are the surgery types [s]
cryotherapy: liquid nitrogen is used which freezes the cells, this is then heated and repeated, which then kills the tumour, this can be used at any time
cystectomy: removal of the bladder
transurethral resection: via the urethra, removes the diseased tissue, the cystoscopy might be the surgical intervention
RT [s]
EBRT or brachy
75% complete response after treatment
rare treatment for T1
chemo [s]
intravesical: localised with it being injected directly into the bladder, unable to wee for two hours after the injection
mitomycin + doxorubicin
delivered for six weeks or as a single
high doses reduce systemic effects but local can be severe
BCG [s]
standard for high risk non muscle invasive bladder cancer (NMIBC)
reduces progression and recurrence
live TB vaccine
induction = weekly intravesical instillation over 6 weeks
maintaince = 6 week instillation every 3 months for 1-3 years
SE = nausea, fever, cough, vomiting and skin rash
better response than chemo: induction dose allows to check that the response is good
what are the surgery types [i]
TUBRT inadequate
Cystoprostourethrectomy: in males, bladder, prostate, urethra and SVs removed
Cystourethrectomy: removal of bladder, urethra in females
RT [i]
T3 tumours
treatment prep for RT
empty bladder and rectum (small volume, less area treated)
patient position
supine, arms on chest, knee rest, foot stop
what are the OAR
rectum and femoral head
what is the RT technique
four field (three field plan: ant + two lat wedged fields or ant + two oblique wedged fields)
TV
GTV difficult to define
PTV = whole bladder with 1.5-2cm margin to allow for variation day to day
verification
isocentre check
CBCT
image: 1,2,3 weekly
dose prescription
55Gy in 20 fractions in 4 weeks at 10MV
64Gy in 32 fractions in 6.5 weeks at 10MV
what type of imaging method is used
IGRT/IMRT
more precise tailoring of the dose reducing late effects
what is adaptive RT
it is when a best fit plan is used which is adapted on a diy basis, creates an optimal plan
RAIDER trial
what is BCON RT
Bladder Carbogen Oxygen Nicotinamide
- hypoxic cells are sensitised by BCON so has a better outcome with RT
carbogen is mixed with oxygen (o2 inhaled before and after RT)
nicotinamide: orally 1.5-2 hours before RT
increase in survival at 10 years = 32%
acute SE
radiation induced cystitis: MSU
diarrhoea: low fibre, ammodium
may pass blood clots
late SE
bladder fibrosis: RT can scar the epithelial lining, less bladder volume so results in chronic frequency
talengiectsia: prone to bleeding, heating can heal the capillaries
bowel complications: talengiectasia, ulceration
what is prognosis dependent on
stage and nodal involvement
what happens if nodes are involves
five year survival decreases to 10-15%
early detection =
better prognosis
is there any long term survivors
no
T1 prognosis
80%
T2 prognosis
55-65%
T3 prognosis
40-45%
T4 prognosis
25-30%
