Urothelial Cancer - TCC Flashcards
Where are most Transistional Cell Carcinomas found?
In the bladder
Other than TCC what kinds of urothelial cancer can present? [2]
Squamous CC - Mainly in countries where schistosomiasis is endemic
Adenocarcinoma - Rare Urachal malignancy
Risk factors for TCC? [3]
Smoking
Aromatic Amines (analine dye hairdressers, rubber industries)
Non-hereditary genetic abnormalities p52, Rb
Risk factors for SCC? [5]
Schistosomiasis (S. Haematobium only)
Chronic cystitis (UTIs, catheters & stones)
Cyclophosphamide
Pelvic RT
How does Bladder cancer tend to present? [4]
- Mostly with Painless Haematuria
- Storage symptoms: dysuria, frequency, not curia, urgency, bladder pain
- Metastatic or invasive symptoms
- Recurrent UTIs
What main investigations would you run for Bladder Cancer? [4]
CT Urogram
USS
Followed by Cystourethroscopy & biopsy
What other tests can be done for bladder cancer? [2] Explain the underlying rationale for each [2]
What blood tests would you do [3]
Urine culture - rules out UTI as cause of haematuria
Urine cytology - RBC casts, cremated red cells
Bloods: U&E and creatinine, corrected calcium
What investigations are used to stage Bladder Cancer? [3]
CT/MRI abdo & pelvis Bone Scan (if bone mets symptoms) CT-Urogram (looks for upper tract tumours)
What are the major treatments for Bladder Cancer? [6]
Endoscopic resection - TURBT (transurethral resection of bladder tumour)
Fluorescent Cystoscopy - Good for CIS
- Intravesicle Chemo
- Intravesicle BCG Therapy
- Radical Surgery
- Radiotherapy
What is BCG therapy? [2]
Bacillus Calmette-geurin Therapy (form of immunotherapy)
BCG is a germ similar to Mycoplasma Tuberculosis [1] but doesn’t cause serious disease, its put into the bladder to stimulate the immune system. [1]
Describe grading of bladder cancer [3]
Describe the staging of bladder cancer [5]
Grade 1-3 based on how poorly differentiated and so how aggresive it is.
Low grade = papillary, high grade = flat
Cis - Non-muscle invasive but extremely aggressive
Ta = non invasive papillary T1 = invades lamina propria T2 = invades muscular propria T3 = invades perivesical tissue T4 = invades prostatic stroma, seminal vesicles, uterus, etc
Whats the prognosis for bladder cancer? Non-invasive vs invasive high grade [2]
Non-invasive low grade cancer is good 90% 5 yr survival
Invasive high grade or CIS is bad - 50% 5 yr survival
How would you treat a low grade non-muscle invasive cancer? [4]
1) Endoscopic resection (TURBT)
2) Followed by 1 dose of intravesicle chemo (Mitomycin C)
Then endoscopic follow ups to monitor, if it recurs do 6 wks of intravesicle chemo [2]
How would you treat a high grade non-muscle invasive cancer? [2]
1) Endoscopic (TURBT)
2) Followed by intravesical BCG therapy (weekly for 3 wks every month for 3 yrs)
What happens if a patient becomes refractory to BCG therapy?
Radical Surgery
