Urothelial (Bladder) Cancer Flashcards
Where in the urinary tract is urothelial cancer most common?
Bladder (Risk factors more concentrated)
What are some risk factors for bladder cancer?
Smoking
Increased age
Schistosomiasis
Aromatic amines (E.g. Beta-naphthaline)
Where is schistosomiasis most common?
Central Africa
Where are aromatic amines found?
They were used in dye and rubber industries but are now heavily regulated and have been banned for many years
Characteristics of transitional cell carcinoma
Most commonly papillary - Finger-like projections
Possible flat lesions on a background of carcinoma in-situ
Characteristics of adenocarcinoma
Can be primary
May occur on a background of metaplasia or invasive colon cancer
Characteristics of urachal adenocarcinoma
Cancer of the remnant of the allantois from the dome of the bladder to the umbilicus
Characteristics of squamous cell carcinoma
- Persistent inflammation gives rise to squamous metaplasia
- Metaplastic epithelium is unstable - increased risk of malignancy
How will bladder cancer present?
80% present with frank haematuria (Mostly painless)
What investigations are required in suspected bladder cancer?
CT urogram
Flexible cystoscopy
How is a CT urogram performed in diagnosing bladder malignancy
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
What is shown?
Bladder mass on CT-urogram
What is shown?
Bladder cancer on cystoscopy
Coral appearance
What are the TNM stages of bladder cancer?
Describe the prognosis of bladder cancer based on staging
How is low risk bladder cancer managed?
Monitoring:
- Cystoscopy
- Urine cytology
- Every 6 months for
How is high risk bladder cancer managed?
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
What is intravesical therapy for high risk bladder cancer?
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
How is muscle invasive bladder cancer managed?
Surgery and external beam radiotherapy
What surgery is required in muscle invasive bladder cancer?
- 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
How is metastatic bladder cancer managed?
Cisplatin-based chemotherapy
What is the prognosis of metastatic bladder cancer
Average life-span in metastatic disease is < 1 year
