Urology - bladder cancer

Question 1

Risk factors for bladder cancer

Answer 1

Smoking
Increased age

Aromatic amines (carcinogen found in dye and rubber historically and in cigarette smoke)

Schistosomiasis is a cause of squamous cell carcinoma of the bladder

Question 2

Types of bladder cancer

Answer 2

• Transitional cell carcinoma (90%)

Squamous cell carcinoma (5% – higher in areas of schistosomiasis)

Question 3

Presentation of bladder cancer

Answer 3

Painless haematuria

Question 4

When should patients be referred under 2WW?

Answer 4

Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI

Aged over 60 with microscopic haematuria (not visible but positive on a urine dipstick) PLUS:

• Dysuria or;
• Raised white blood cells on a full blood count

Non-urgent referral also in over 60s with recurrent UTIs

Question 5

Diagnosis of bladder cancer is with

Answer 5

Cystoscopy under local or general anaesthetic

Biopsy

Question 6

Treatment options for bladder cancer

Answer 6

MDT

Transurethral resection of bladder tumour (TURBT) may be used for non-muscle-invasive bladder cancer. The involves removing the bladder tumour during a cystoscopy procedure.

Intravesical chemotherapy to reduce risk of recurrence

Intravesical BCG vaccine can be used (thought to stimulate immune system to attack tumour)

Radical cystectomy e.g. for muscle-invasive tumour or high risk disease

Chemotherapy and radiotherapy may also be used

Question 7

Classification of bladder cancer

Answer 7

Non-muscle-invasive bladder cancer – does not penetrate into the deeper layers of the bladder wall (around 70-80% cases)

Muscle-invasive bladder cancer – penetrates into the deeper layers of the bladder wall

Question 8

How does the urine drain out after cystectomy?

Answer 8

Insertion of urostomy - bypassing the ureters, bladder and urethra.

Other options are neobladder reconstruction (from section of ileum) or continent urinary diversion