Urological Malignancy - Bladder Cancer Flashcards

1
Q

Give 4 risk factors of Transitional Cell Carcinoma.

A
  1. Smoking.
  2. Increased Age.
  3. Amines, Polycyclic Aromatic Hydrocarbons, Arsenic, Tetrachloroethylene (hair dyes, industrial paints, rubber, motor, leather) 15-40 years later.
  4. Cyclophosphamide.
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2
Q

Give 2 risk factors of Squamous Cell Carcinoma in the Bladder.

A
  1. Schistomiasis (Snail Fever).

2. Long-Term Bladder Catheterisation (10+ Years).

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3
Q

What is Schistomiasis?

A

Snail Fever caused by parasitic flatworms to cause chronic bladder infection which can lead to bladder cancer.

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4
Q

Epidemiology of Bladder Cancer.

A

Most commonly affects males aged between 50-80.

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5
Q

Clinical Presentation of Bladder Cancer (5).

A
  1. Painless Haematuria.
  2. Frequency.
  3. Urgency.
  4. Dysuria.
  5. Urinary Tract Obstruction.
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6
Q

Stereotypical Patient.

A

Retired Dye Factory Worker, presenting with painless haematuria.

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7
Q

Types of Bladder Cancers (2).

A
  1. 90% Transitional Cell Carcinomas.

2. 10% Squamous Cell Carcinomas.

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8
Q

What is a Papillary Urothelial Carcinoma?

A

Malignant tumour (TCC) arising from the transitional epithelium with finger-like projections - usually superficial and better prognosis.

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9
Q

Classification of Bladder Cancers (3).

A
  1. Low-Risk = Superficial Bladder Cancers.
  2. High-Risk = Muscle-Invasive Bladder Cancers.
  3. Carcinoma-In-Situ (CIS).
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10
Q

Properties of Low-Risk Superficial Bladder Cancers (5).

A
  1. Do not invade beyond Muscularis Propria (Detrusor).
  2. Low-Grade.
  3. Papillary Architecture.
  4. Require : Regular Follow-ups (High Chance of Recurrence).
  5. Management : Removal using TURBT via Cystoscopy and Intravesical Chemotherapy post-TURBT.
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11
Q

Properties of High-Risk Muscle-Invasive Bladder Cancers (5).

A
  1. Invade Detrusor and beyond.
  2. High-Grade.
  3. Solid Tumours.
  4. Worse Prognosis - higher risk of spreading to regional lymph nodes and metastasis.
  5. Management : Radical Treatment - Cystectomy.
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12
Q

What is a Carcinoma in Situ of TCC?

A

A flat lesion (no mass) in which the urothelium contains cells that display the nuclear features associated with malignancy but no invasion through the basement membrane.

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13
Q

Investigation of CIS TCC.

A
  1. Cystocopy - Red patches - blue-light cystoscopy : HAL (Hexyl minolevulinate).
  2. Urine Cytology - Highly atypical cells are shed into urine.
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14
Q

Prognosis of CIS TCC.

A

Left-untreated : 40% turn into Muscle-Invasive High-Risk Cancer.

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15
Q

What mutations are associated with the 3 types of TCC?

A
  1. HRAS and FGFR3 - Superficial.

2. TP53 and RB1 - Muscle-Invasive and CIS.

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16
Q

What is the importance of visible haematuria?

A

Bladder cancer until proven otherwise.

17
Q

What are the relevant 2-week wait rules?

A
  1. Anyone aged over 45 with unexplained haematuria without a UTI or persisting after treatment for a UTI.
  2. Anyone over 60 with microscopic haematuria and either dysuria or raised WCC on bloods.
18
Q

Which patients should be referred non-urgently?

A

People over 60 with recurrent unexplained UTIs.

19
Q

Investigations of TCC :-

  • Staging.
  • Grading.
  • Diagnosis.
A

Diagnosis : Cystoscopy and Biopsy.
Staging : TNM - Locoregional : Pelvic MRI; Distant - CT.
Grading : 3 Tier System (1 - Well-Differentiated; 3 - Poorly-Differentiated).

20
Q

Management of TCC (2).

A
  1. Non-Muscle Invasive : TURBT (Transurethral Resection of a Bladder Tumour) + Chemotherapy + Immunotherapy.
  2. Muscle-Invasive : Radical Cystectomy + Urostomy with Ileal Conduit.
21
Q

Immunotherapy in Bladder Cancer.

A

Weekly treatments for 6 weeks - BCG vaccine is squirted into bladder via the catheter then every 6 months for 3 years - stimulates immune system to attack bladder tumour.

22
Q

Options for Draining Urine Following Radical Cystectomy (4).

A
  1. Urostomy with Ileal Conduit.
  2. Continent Urinary Diversion.
  3. Neobladder Reconstruction.
  4. Uterosigmoidostomy.
23
Q

Urostomy with an Ileal Conduit (3).

A
  1. Ileal Section anastomosed to ends of ureters and stoma on skin.
  2. Kidneys - Ureters - Ileal Conduit - Urostomy Bag.
  3. Fit tightly around urostomy to avoid urine coming into contact with skin.