Urological malignancies Flashcards
Bladder cancer, prostate cancer, testicular cancer
What are the 3 main types of bladder cancer?
Urothelial carcinoma (transitional cell carcinoma) is the most common type, accounting for about 90% of cases.
Other types include squamous cell carcinoma and adenocarcinoma.
What are the major risk factors for developing bladder cancer? Which one is the most significant one?
- Age and male
- Smoking (the most significant risk factor)
- Occupational exposure to certain chemicals (e.g., in dye, rubber, leather industries)
- Chronic bladder inflammation (e.g., from infections or long-term catheter use)
- Previous radiation therapy or chemotherapy (e.g., cyclophosphamide
What are the common symptoms of bladder cancer?
- Painless hematuria (blood in the urine)
- May also present with irritative urinary symptoms e.g. dysuria, increased frequency/urgency due to irritation to bladder (possible muscle-invasive stages)
- Pelvic pain, symptoms of malignancy if cancer is more advanced.
What is the haematuria like in bladder cancer?
- Often painless, either gross or microscopic
- Intermittent in frequency
What is a major risk factor for squamous cell carcinoma?
Chronic schistosomiasis/ long-term catheter use.
What are two subtypes of transitional cell bladder carcinomas? What are their characteristics and prognostic features?
Papillary TCC: The most common form of bladder cancer, characterised by exophytic, frond-like growths that project into the bladder lumen. These tumours often present as non-muscle-invasive (e.g., Ta, T1) and have a relatively better prognosis.
Flat TCC: This form includes carcinoma in situ (CIS), a high-grade, flat lesion that remains confined to the bladder mucosa but has a high risk of progression to invasive disease.
How are bladder cancers grossly classified?
- Non-muscle-invasive (confined in the urothelium) - T1s
- Muscle-invasive (invade the detrusor muscle - T2s, invasion of surrounding structures -T3s
- Metastatic
What is a major risk factor fo bladder adenocarcinomas?
Rare, usually arising from glandular differentiation
- Chronic inflammation or
- Bladder exstrophy.
What is the criteria for cancer pathway referral for bladder cancer?
Over 45s and over 60s
- People aged ≥ 45 with unexplained visible haematuria without UTI or visible haematuria that persists/recurs after UTI
- People aged ≥ 60 with non-visible haematuria and either dysuria or raised WCC on blood tests
As a GP, what initial investigations would you perfrom upon suspicion of bladder cancer?
Urinalysis: dipstick/microscopy, and urine cytology: haematuria, cell changes suggestive of tumour
Negative urine culture.
What is the gold standard diagnostic tool for bladder cancers? (performed by urologists)
- **Cystoscopy (direct visualisation) ** - try flexible first, then rigid if suspicious of muscle invasion. (require regional or general anaesthetic)
- TURBT (Transurethral Resection of Bladder Tumour): Diagnostic and therapeutic procedure that involves resecting visible tumours and assessing muscle invasion — destrusor muscle taken.
Biopsy: histopathology – type, grade, depth of invasion.
Upon flexible cystoscopy, you suspect a muscle-invasive bladder cancer. What are your next steps?
- Consider CT urogram or MRI staging to assess for metastasis.
- Then, perform transurethral resection of bladder tumour (TURBT)
How is bladder cancer staged? Using which scans?
If suspecting a muscle-invasive cancer/ high-grade carcinoma in situ
- CT urography
- MRI e.g. soft tissue
- Consider CT for other areas.
How is bladder cancer staged? List 4 layers of the bladder
- Urothelium (Ta, Tis/high-grade)
- Lamina propria/ subepithelial connective tissue (T1)
- Detrusor muscle (T2)
- Fat layer (T3)
- Other organs/structure (T4)
List 2 management options for Non-muscle-invasive bladder cancer (NMIBC)
- Trans urethral resection of bladder tumour (TURBT): First-line treatment with resection of the tumour.
- Intravesical therapy: Bacillus Calmette-Guérin (BCG) instillation is the mainstay for high-risk NMIBC, reducing recurrence and progression. Mitomycin C is an alternative for lower-risk disease.
