Urinary Bladder Flashcards

1
Q

epidemiology

A

2.6:1 (M:F)
rare in under 50s, 2/3 are 65+
twice more likely in caucasians
11th most common
10 year survival

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2
Q

aetiology

A

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

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3
Q

what cell is the tumour

A

transitional cell carcinoma

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4
Q

investigations

A

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]

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5
Q

presentation

A

painless haematuria
urgency
frequency
dysuria
reduction in urine stream
pain: outside bladder
obstruction = renal failure

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6
Q

what are met symptoms

A

pathological fracture
no function in legs
pain up and down legs
impact on urinary function
difficulty breathing
haemopytsis
SOB

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7
Q

what is the Macro pathology

A

80% papillary
12% will be invasive

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8
Q

appearance of solid invasive

A

looks nodular and ulcerated, which is rapidly growing invading through the bladder wall, increases met spread through lymphatics

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9
Q

what is the micro pathology

A

TCC = 90%
SCC incidences are high when there is schistomiasis present
adenocarcinomas are rare
sarcomas, lymphomas, small cell and melanomas are very rare

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10
Q

treatment for superficial

A

dependent on the cancer type
recurrence rate is 60%
active surveillance is needed

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11
Q

what are the surgery types [s]

A

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

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12
Q

RT [s]

A

EBRT or brachy
75% complete response after treatment
rare treatment for T1

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13
Q

chemo [s]

A

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

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14
Q

BCG [s]

A

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

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15
Q

what are the surgery types [i]

A

TUBRT inadequate
Cystoprostourethrectomy: in males, bladder, prostate, urethra and SVs removed
Cystourethrectomy: removal of bladder, urethra in females

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16
Q

RT [i]

A

T3 tumours

17
Q

treatment prep for RT

A

empty bladder and rectum (small volume, less area treated)

18
Q

patient position

A

supine, arms on chest, knee rest, foot stop

19
Q

what are the OAR

A

rectum and femoral head

20
Q

what is the RT technique

A

four field (three field plan: ant + two lat wedged fields or ant + two oblique wedged fields)

21
Q

TV

A

GTV difficult to define
PTV = whole bladder with 1.5-2cm margin to allow for variation day to day

22
Q

verification

A

isocentre check
CBCT
image: 1,2,3 weekly

23
Q

dose prescription

A

55Gy in 20 fractions in 4 weeks at 10MV
64Gy in 32 fractions in 6.5 weeks at 10MV

24
Q

what type of imaging method is used

A

IGRT/IMRT
more precise tailoring of the dose reducing late effects

25
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
26
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%
27
acute SE
radiation induced cystitis: MSU diarrhoea: low fibre, ammodium may pass blood clots
28
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
29
what is prognosis dependent on
stage and nodal involvement
30
what happens if nodes are involves
five year survival decreases to 10-15%
31
early detection =
better prognosis
32
is there any long term survivors
no
33
T1 prognosis
80%
34
T2 prognosis
55-65%
35
T3 prognosis
40-45%
36
T4 prognosis
25-30%