Urothelial (Bladder) Cancer

Question 1

Where in the urinary tract is urothelial cancer most common?

Answer 1

Bladder (Risk factors more concentrated)

Question 2

What are some risk factors for bladder cancer?

Answer 2

Smoking
Increased age
Schistosomiasis
Aromatic amines (E.g. Beta-naphthaline)

Question 3

Where is schistosomiasis most common?

Answer 3

Central Africa

Question 4

Where are aromatic amines found?

Answer 4

They were used in dye and rubber industries but are now heavily regulated and have been banned for many years

Question 6

Characteristics of transitional cell carcinoma

Answer 6

Most commonly papillary - Finger-like projections
Possible flat lesions on a background of carcinoma in-situ

Question 7

Characteristics of adenocarcinoma

Answer 7

Can be primary
May occur on a background of metaplasia or invasive colon cancer

Question 8

Characteristics of urachal adenocarcinoma

Answer 8

Cancer of the remnant of the allantois from the dome of the bladder to the umbilicus

Question 9

Characteristics of squamous cell carcinoma

Answer 9

• Persistent inflammation gives rise to squamous metaplasia
• Metaplastic epithelium is unstable - increased risk of malignancy

Question 10

How will bladder cancer present?

Answer 10

80% present with frank haematuria (Mostly painless)

Question 11

What investigations are required in suspected bladder cancer?

Answer 11

CT urogram
Flexible cystoscopy

Question 12

How is a CT urogram performed in diagnosing bladder malignancy

Answer 12

Contrast given 10 minutes before the scan to allow it to pass into the bladder
CT scan is then performed, showing any abnormalities of filling

Question 13

What is shown?

Answer 13

Bladder mass on CT-urogram

Question 14

What is shown?

Answer 14

Bladder cancer on cystoscopy
Coral appearance

Question 15

What are the TNM stages of bladder cancer?

Answer 15

Question 16

Describe the prognosis of bladder cancer based on staging

Answer 16

Question 17

How is low risk bladder cancer managed?

Answer 17

Monitoring:
- Cystoscopy
- Urine cytology
- Every 6 months for

Question 18

How is high risk bladder cancer managed?

Answer 18

Intravesical therapy then monitoring:
- Cystoscopy and urine cytology
- Every 3 months for 1 year
- Every 6 months from 1-5 years
- Every 12 months from 5-10 years

Question 19

What is intravesical therapy for high risk bladder cancer?

Answer 19

Intravesical therapy involves administration of BCG (Effectively a TB vaccine) into the bladder to cause an inflammatory response and aim to destroy the cancer cells immunologically

Question 20

How is muscle invasive bladder cancer managed?

Answer 20

Surgery and external beam radiotherapy

Question 21

What surgery is required in muscle invasive bladder cancer?

Answer 21

• Surgery is with radical cystectomy
• In men, there is also removal of some of the intestines
• In women, a large amount of the reproductive organs are also removed
• In most cases, the kidneys are plumbed into the intestines, which drains into a stoma bag
• In others cases, there is the formation of a new bladder using bowel tissue, however, there is no detrusor muscle, and so requires the valsalva manouvre to open the sphincters

Question 22

How is metastatic bladder cancer managed?

Answer 22

Cisplatin-based chemotherapy

Question 23

What is the prognosis of metastatic bladder cancer

Answer 23

Average life-span in metastatic disease is < 1 year