Urological Cancers

Question 1

Cancer of which organ is the most common tumour of the urinary system?

Answer 1

Bladder cancer

Question 2

Is bladder cancer more common in men or women?

Answer 2

Men (ratio 3:1)

Question 3

What are the different types of cancer that can arise in the bladder? Which is the most common?

Answer 3

Transitional cell carcinoma (TCC) (80-90%)

Squamous cell carcinoma
Adenocarcinoma
Sarcoma

Question 4

What are the four layers of the bladder wall?

Answer 4

1) Transitional epithelium (innermost layer)
2) Lamina propria
3) Muscularis propria
4) Fatty connective tissue (outermost layer)

Question 5

What the risk factors for developing bladder cancer?

Answer 5

Smoking 
Increasing age
Exposure to aeromatic hydrocarbons (industrial dyes or rubbers)
Schistosomiasis infection 
Previous radiation to the pelvis

Question 6

Which type of bladder cancer is associated with schistosomiasis infection?

Answer 6

SCC

(associated with chronic bladder irritation, therefore also linked to long-term catheters, recurrent UTI, bladder stones)

Question 7

How might patients with bladder cancer present?

Answer 7

MOST COMMON SYMPTOM = Haematuria - usually visible but also non-visible

Can also have

• recurrent UTIs
• LUTS (frequency, urgency, feeling of incomplete voiding, etc.)

if locally advanced disease
- pelvic pain

if metastatic spread

• weight loss
• lethargy

Question 8

What are the possible differentials for haematuria?

Answer 8

UTI 
Renal calculi 
Bladder cancer
Renal cancer 
Prostate cancer
Trauma
Nephrological causes (e.g. IgA nephropathy)

Question 9

What investigations is required on 2WW if bladder cancer is suscpected?

Answer 9

Flexible cystoscopy
- this is done under local anaesthetic

Biopsy can be take using flexible cystoscopy, however if a suspicious lesion is identified, a rigid cystoscopy might be required (under GA) for a more definitive assessment.

Question 10

What is TURBT?

Answer 10

TransUrethral Rescetion of Bladder Tumour.

Removal of tumour for pathological diagnosis and staging, should include resection through detrusor muscle to confirm/refute muscle invasion.

Question 11

What further staging investigations are required for bladder cancers (except low grade superficial tumours)?

Answer 11

CT urogram
CXR
CT abdomen and pelvis, or CT CAP, or MRI

Question 12

Where does bladder cancer metastasise to?

Answer 12

Pelvic and para-aortic lymph nodes
Bone
Liver
Lungs

Question 13

What is the mainstay of management for T1/Ta (superficial) tumours?

Answer 13

TURBT

+ single dose of intravesical mitomycin

Question 14

What are the management options for non-muscle-invasive bladder cancer?

Answer 14

TURBT
+/- adjuvant intravesical therapy

or

Radical cystectomy (if high risk or limited response to initial treatments)

Question 15

What is the rate of recurrence of superficial bladder tumours?

Answer 15

70% of superficial bladder tumour recur within 3 years

Question 16

What are the management options for muscle invasive bladder cancer?

Answer 16

Radical cystectomy (if fit for surgery)
\+/- neoadjuvant chemotherapy - cisplatin combination regimen

Question 17

Following radical cystectomy, which two procedures could be performed to achieve urinary diversion?

Answer 17

1) Ileal conduit (formed from bowel) - urine will drain via a urostomy
2) Bladder reconstruction (neobladder) formed from a segment of small bowel - urine will drain either urethrally or via a catheter

Question 18

What are the management options for locally advanced or metastatic bladder cancer?

Answer 18

+/- Radical cystectomy (if fit for surgery)

Chemotherapy - either cisplatin based regimen or carboplatin plus gemcitabine based regimen

Sometimes radiotherapy (if not fit for surgery)

Palliative options e.g. palliative chemo

Question 19

What is the rate of 5 year survival rate in patients with superficial bladder cancer?

Answer 19

80-90%

Question 20

What is the 5 year survival rate in patients with muscle invasive and metastatic bladder cancer?

Answer 20

Muscle invasive: 30-60%

Metastatic: 10-15%

Question 21

Can you have superficial squamous of adenocarcinoma in bladder cancer?

Answer 21

No, adenocarcinoma and squamous cell carcinoma of the bladder will always be invasive.