Urology - Bladder Tumours

Question 1

Pathology

Answer 1

• TCC: account for 90% of cases
• SCC: Associated with schistosomiasis (think of this in endemic countries)
• Adenocarcinomas

Question 2

Behaviour of malignancy - low grade and high grade

Answer 2

• Low grade tumours (80%): are non invasive, generally non life threatening and have a high rate of recurrence
• High grade tumours (20%): are invasive and life threatening and have high rate of recurrence

Question 3

Risk factors

Answer 3

• Smoking
• Amine exposure (rubber industry)
• Previous renal TCC
• Chronic cystitis
• Schistosomiasis (SCC)
• Urachal remnant (Adenocarcinomas)
• pelvic irradiation

Question 4

Presentation

Answer 4

• Painless haematuria
• voiding irritability: dysuria, frequency, urgency
• recurrent UTIs
• retention and obstructive renal failure

Question 5

Examination: notable signs

Answer 5

• Anaemia

- palpable bladder mass and palpable liver

Question 6

Possible routes of spread

Answer 6

• local: pelvic structures
• lymph: iliac and para-aortic nodes
• haem: bones, liver and lungs

Question 7

Ix

Answer 7

• Yrine: dip (sterile pyuria), cytology
• IVU: filling defects
• cystoscopy with biopsy: diagnostic
• CT/MRI: staging

Question 8

TNM staging

Answer 8

• Tis: carcinoma in situ
• Ta: confined to epithelium
• T1: tumour in lamina propria
• T2: superficial muscle involved
• T3: deep muscle involved
• T4: invasion of prostate, uterus or vagina

Question 9

Mx: T is, Ta, T1

Answer 9

• Superficial malignancy
• 80% of pts
• Diathermy via transurethral cystoscopy/transurethral resection of Bladder tumour (TURBT)
• Intravesical chemo or immunotherapy

Question 10

Mx: T2 and T3

Answer 10

• Invasive
• Radical cystectomy with ideal conduit (gold standard)
• radiotherapy: worse 5a survival but preserves bladder
• Adjuvant chemo
• Potential role for new adjuvant chemo

Question 11

Mx: T4

Answer 11

• Palliative chemo/radiotherapy

- long term catheterisation/urinary diversions

Question 12

Complications of treatment and TCC

Answer 12

• massive bladder haemorrhage

- cystectomy: sexual and urinary malfunction

Question 13

Follow up post Rx

Answer 13

• up to 70% of bladder cancers recur t/f need intensive f/up
• Hx, examination and regular cystoscopy
• High risk tumours: every 3months for 2ya then every 6/12
• Low risk: at 9/12, then yearly

Question 14

Prognosis

Answer 14

• Depends on stage and age
• T is, Ta, T1: 95% 5ya
• T2: 40-50% 5ya
• T3: 25% 5ya
• T4: <1 year median survival :(