Urology: Bladder Cancer Flashcards
What is the most common type of bladder cancer? [1]
What is the second most common type? [1]
Transitional cell cancer
Squamous cell carcinoma (often occurs if have schistosomiasis)
Adenocarcinomas (rare in West)
Clinical features of bladder cancer? [4]
Painless haematuria: most common symptom
recurrent UTIs
Dysuria
Frequency
Urgency
Suprapubic pain
Risk factors for bladder cancer? [5]
Smoking
Aromatic amines (rubber industry)
Chronic cystitis
Schisosomiasis
Pelvic irradtion
Describe NICE guidelines regarding haematuria that determines investigating for bladder cancer [2]
Painless haematuria:
Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI. 2/3 samples positive for blood require investigation
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
What type of occupation is bladder cancer common to? [1]
Any with aromatic amines: factory worker working with dyes or rubber
What investigations would you conduct for bladder cancer:
- All patients given? [1]
- NVH v VH? [2]
All patients given cytoscopy (rigid or flexible) - with biospy: diagnostic
NVH: USS renal tract
VH: CT urogram
Staging for bladder cancer is initially determined via histological biopsies made using which sampling technique? [1]
Subsequent staging of bladder cancer is determined via which methods? [3]
TURBT (Transurethral resection of bladder tumour):
- Muscle invasive
- Non-muscle invasive
Staging investigations:
* CT or MRI of pelvis
* Chest x-ray
* Bone scan
The management of bladder cancer may be classified according to which stages of bladder cancer? [3]
- Low risk non-muscle Invasive Bladder Cancer (NMIBC)
- Moderate risk muscle Invasive Bladder Cancer (MIBC)
- Metastatic Bladder Cancer
Describe the treatment for Mild [2], Intermediate [2] & High [3] risk patients of Non-Muscle Invasive Bladder Cancer (NMIBC)
Mild:
- Transurethral resection of bladder tumor (TURBT): provides diagnosis, staging, and initial treatment of diathermy
- Post TURBT - Intravesical chemotherapy (mitomycin or gemcitabine) given using a catheter: reduces risk of relapse
Moderate:
- Transurethral resection of bladder tumor (TURBT): provides diagnosis, staging, and initial treatment
- Post TURBT - Intravesical chemotherapy (mitomycin) given using a catheter; 6 doses - liquid place directly in bladder
High:
- Transurethral resection of bladder tumor (TURBT): X2
- BCG vaccine
- Cystectomy – totally remove the bladder
State 4 AEs of BCG vaccine for bladder cancer treatment [4]
- a frequent need to urinate
- pain when urinating
- blood in your urine (haematuria)
- flu-like symptoms, such as tiredness, fever and aching
- urinary tract infections
Describe treatment for Muscle Invasive Bladder Cancer (MIBC) [3]
Radical cystectomy: - gold standatd
- Complete surgical removal of the bladder, prostate or uterus, and regional lymph nodes
- Requires urinary diversion
Radiotherapy:
- organ sparing
(Adjuvant &/OR) Chemotherapy:
- Cisplatin before radical cystectomy
Describe the treatment for metastatic bladder cancer [3]
First-line therapy:
- platinum-based combination chemotherapy, such as gemcitabine-cisplatin or dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC).
Immune checkpoint inhibitors:
- For patients ineligible for cisplatin or after progression on first-line chemotherapy, pembrolizumab, atezolizumab, or nivolumab are options.
Targeted therapy:
- For patients with specific molecular alterations (e.g., FGFR3), targeted therapies like erdafitinib may be considered.
What Tumour staging includes invasive bladder cancer? [1]
Invasive bladder cancer includes T2 – 4 and any lymph node or metastatic spread.
Describe the therapy options provided post-radical cystectomy [4]
Ileal conduit:
- A section of the ileum (15 – 20cm) is removed, and end-to-end anastomosis is created so that the bowel is continuous.
- The ends of the ureters are anastomosed to the separated section of the ileum.
- The other end of this section of the ileum forms a stoma on the skin, draining urine into a urostomy bag
Continent urinary diversion:
- Create a pouch inside the abdomen from a section of the ileum, with the ureters connected and fills with urine
- A thin tube is connected between a stoma on the skin and the internal pouch
- Urine does not drain from the stoma (unlike a urostomy), and the patient needs to intermittently insert a catheter into the stoma to drain urine from the pouch.
Neobladder formation:
- Formed from ileum; connected to both ureters and urethra
- Functions as normal bladder
Ureterosigmoidostomy (rare)
- Attaching the ureters directly to the sigmoid colon.
- The rectum may be expanded to create a recto sigmoid pouch (called a Mainz II procedure) to create a larger space for urine to collect.
- The patient can then drain the urine by relaxing the anal sphincter in the same way they open their bowels.
The majority (70-80%) of bladder cancers are non-muscle invasive at presentation, which includes Ta ([]), Tis ([]), and T1 ([]) stages.
The majority (70-80%) of bladder cancers are non-muscle invasive at presentation, which includes Ta (non-invasive papillary), Tis (carcinoma in situ), and T1 (invasion into the lamina propria) stages.
What is the name for this operation? [1]
Continent urinary diversion
Name this operation [1]
Ileal conduit
