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Year Two - Urinary System > Urinary Bladder Cancer > Flashcards

Urinary Bladder Cancer Flashcards

1
Q

What is urothelial cancer?

A

It is defined as cancer that begins in the urothelium lining the renal pelvis, ureters and urinary bladder

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2
Q

What is another name for urothelial cancer? Why?

A

Transitional cell cancer

This is cancer due to the fact that the urothelium consists of transitional epithelial cells

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3
Q

What is the main urothelial cancer?

A

Bladder cancer

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4
Q

What are the six risk factors of bladder cancer?

A

Age, with individuals over the age of 55 having an increased risk

Gender, with males having an increased risk of bladder cancer

Family History, with individuals having an increased risk if their family members have received a diagnosis of bladder cancer or hereditary nonpolyposis colorectal cancer (HNPCC)

Smoking

Chemical Exposure, such as to aniline dyes, arsenic and 2-naphylamine

Previous Cancer Treatment, with cyclophosphamide and radiation therapies aimed at the pelvis increasing the risk of bladder cancer

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5
Q

What is the main risk factor of bladder cancer?

A

Smoking

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6
Q

Why does smoking increase the risk of bladder cancer?

A

This is due to harmful chemicals accumulating in the urine and thus damaging the lining of the bladder

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7
Q

Why do harmful chemicals increase the risk of bladder cancer?

A

This is due to the fact that the kidneys have a role in filtering harmful chemicals from the bloodstream into the bladder, which can therefore damage its lining.

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8
Q

What are the six clinical features of bladder cancer?

A

Haematuria, which is the presence of blood within urine.

Polyuria, which is an increased urine output > 3L per 24hrs

Urinary Urgency

Nocturia, which is clinically defined as waking up at night on more than one occasion to micturate

Dysuria, which is defined as painful or difficulty in urinating

Recurrent UTIs, which is defined as more than four urinary tract infections per year

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9
Q

What are the three types of haematuria?

A

Visible

Microscopic

Dipstick positive

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10
Q

What type of haematuria tends to present in bladder cancer?

A

Painless visible (frank) haematuria

Therefore, patients present with the appearance of pink-coloured urine

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11
Q

What four investigations are used to diagnose bladder cancer?

A

Cystoscopy

Ultrasound Scan

CT Urogram

Urine Cytology

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12
Q

What is the gold standard investigation used to diagnose urinary bladder cancer?

A

Cystoscopy

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13
Q

What is a cystoscopy?

A

It involves the clinician inserting a cystoscope camera through the urethra and into the bladder

This allows the examination of these structures for evidence of disease

During cystoscopy, a biopsy can be collected which can then be analysed histologically for the presence of cancerous cells.

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14
Q

What is fluorescent cystoscopy?

A

It involves intravesical instillation of a photosensitising agent

This is followed by cystoscopy with a fluorescent blue light source

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15
Q

What photosensitising agent is used in fluorescent cystoscopy?

A

5-ALA

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16
Q

How can fluorescent cystoscopy be used to diagnose bladder cancer?

A

Rapidly metabolising cells will result in reflected red light instead of blue

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17
Q

How is an ultrasound scan used to diagnose bladder cancer?

A

It is used to identify evidence of bladder cancer and to stage the cancer – by determining its size and the presence of metastases

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18
Q

What is a CT urogram?

A

An investigation using a CT scan and contrast medium to look at the urinary system

The contrast medium allows the urinary system to appear more clearly

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19
Q

How is a CT urogram used to diagnose bladder cancer?

A

It is used to identify evidence of bladder cancer and to stage the cancer – by determining its size and the presence of metastases

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20
Q

What is a urine cytology?

A

It involves the analysis of urine under a microscope – allowing cancerous cells to be identified

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21
Q

What two investigations are used to definitively diagnose bladder cancer?

A

CT urogram

Ultrasound scan

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22
Q

When do we conduct bladder cancer investigations when patients over the age of 50 present with visible haematuria?

A

Within 2 weeks

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23
Q

When do we conduct bladder cancer investigations when patients over the age of 50 present with microscopic or dipstick haematuria?

A

Within 4-6 weeks

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24
Q

What is grading?

A

The assessment of the cancer’s aggressiveness

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25
Q

What is grading based on?

A

It is based upon the cancer’s histological differentiation and therefore requires a bladder biopsy to be determined

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26
Q

What is grading used to determine?

A

Prognosis outcome

To guide treatment

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27
Q

How do we grade bladder cancer?

A

Low grade (G1)

High grade (G3)

28
Q

What is low grade bladder cancer?

A

It is defined as a well differentiated tumour, in which cells are closer in appearance and organisation to normal cells

29
Q

How do low grade bladder cancers grow and metastasise?

A

They grow slowly

They rarely invade the muscular wall of the bladder

30
Q

What is high grade bladder cancer?

A

It is defined as a poorly differentiated tumour, in which the cells appear abnormal and lack any resemblance to normal-appearing tissues

31
Q

How do high grade bladder cancers grow and metastasise?

A

They grow more aggressively

They tend to spread to the muscular wall of the balder and other organs

32
Q

What is a carcinoma in-situ?

A

It is a pre-cursor for muscle invasive cancer, in which cells appear abnormal however are not invasive yet

It is a very aggressive type of cancer that requires different form of treatment

33
Q

What is staging?

A

The assessment of a cancer’s spread

34
Q

What is staging based on?

A

It is based upon clinical and radiological assessment

35
Q

What is staging used to determine?

A

Prognosis outcome

To guide treatment

36
Q

What two methods are used to stage bladder cancer?

A

Localised Bladder Cancer Staging

TNM Staging

37
Q

What is bladder cancer stage zero?

A

It is defined as a tumour (stage 0a) or carcinoma in-situ (stage 0is) contained within the mucosa lining of the bladder lining

38
Q

What is bladder cancer stage one?

A

It is defined as a bladder tumour involving the lamina propria bladder layer

39
Q

What is bladder cancer stage two?

A

It is defined as a bladder tumour involving the superficial muscle bladder layer

40
Q

What is bladder cancer stage three?

A

It is defined as a bladder tumour involving the deep muscle bladder layer

41
Q

What is bladder cancer stage four?

A

It is defined as a bladder tumour which has metastasised to other organs and structures within the body.

42
Q

What is T stage in TNM staging?

A

It considers how big the tumour is and how far it has spread

43
Q

What is N stage in TNM staging?

A

It considers whether the cancer cells have spread into the lymph nodes

44
Q

What is M stage in TNM staging?

A

It considers whether the tumour has spread anywhere else in the body

45
Q

How do we determine the M stage in TNM staging?

A

CT scan of chest, abdomen and pelvis

46
Q

How do we treat bladder cancer?

A

Surgical treatment

Chemotherapy treatment

Radiotherapy treatment

47
Q

What three surgeries are used to treat bladder cancer?

A

Transurethral Resection of Bladder Tumour (TURBT)

Cystectomy

Neobladder Reconstruction

48
Q

When is TURBT used to treat bladder cancer?

A

When the cancer is confined to the inner layers of the bladder, therefore those that are non-muscle invasive

49
Q

What is TURBT?

A

A surgeon passes an electric wire loop through a cystoscope and into the bladder

The electric current in the wire is used to cut or burn away the cancer

50
Q

What is cystectomy?

A

A surgical procedure in which all or part of the bladder is removed

51
Q

What is a partial cystectomy?

A

It involves the clinician removing only a portion of the bladder that contains the cancerous tumour

52
Q

What is a radical cystectomy?

A

It involves the clinician removing the entire bladder and surrounding lymph nodes

53
Q

What is neobladder reconstruction?

A

After a radical cystectomy, a new conduit for urine to leave the body must be created

54
Q

What are the two types of neobladder reconstructions?

A

Incontinent Conduit

Continent Conduit

55
Q

What is an incontinent conduit?

A

It involves the surgeon creating a tube using the ilium

The tube runs from the ureters into a urostomy bag in the abdomen

56
Q

What is a continent conduit?

A

It involves the surgeon using the intestine to create a reservoir to hold urine

The urine is drained from the reservoir through a suprapubic catheter a few times each day

57
Q

What occurs after a neobladder reconstruction? Why?

A

Chemotherapy is injected into the bladder

This destroys any remaining cancer cells and prevents reoccurrence

58
Q

What chemotherapy treatment is given to low grade cancer patients after neobladder reconstruction? What is given if the patient has a bad prognosis?

A

A one-time injection of mitomycin C is usually prescribed

However, if the patient has a bad prognosis, a prolonged chemotherapy course of six weeks is usually recommended

59
Q

What chemotherapy treatment is given to high grade cancer and CIS patients after neobladder reconstruction?

A

A weekly injection of intravesical BCG for three weeks

60
Q

When is chemotherapy used to treat bladder cancer?

A

It is used as a neoadjuvant treatment for muscle invasive bladder cancers, followed by radical surgery or radical radiotherapy

61
Q

What three chemotherapy agents are used to treat bladder cancer?

A

Mitomycin C

GC Regimen (Gemcitabine & Cisplatin)

MVAC Regimen (Methotrexate, Vinblastine, Adriamycin & Cisplatin)

62
Q

When is radiotherapy used to treat bladder cancer?

A

It is usually combined with chemotherapy to treat muscle-invasive cancer in cases where patients are unsuitable for surgery

63
Q

What is the cause of squamous cell carcinoma of the bladder?

A

Schistosomiasis

64
Q

What drug increases the risk of bladder cancer?

A

Pioglitazone

65
Q

How is localised spread of bladder cancer determined?

A

MRI scan of pelvis

Year Two - Urinary System (15 decks)

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