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Urinary > Urothelial Cancers > Flashcards

Urothelial Cancers Flashcards

1
Q

Where can Urothelial cancers occur

A

occur at any point from real callouses to the tip of the urethra

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2
Q

What is the most common site for a Urothelial cancer

A

The bladder (90%)

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3
Q

What is urothelial cancer also known as

A

Transitional cell carcinoma

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4
Q

What is the 5 year survival rate of a Non-invasive, low grade bladder TTC

A

90%

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5
Q

What is the 5 year survival rate of a invasive, high grade bladder TTC

A

50%

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6
Q

What % of bladder cancers are TCC

A

90%

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7
Q

What is the other cell type found in bladder cancer apart from TCC

A

Squamous cell carcinoma

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8
Q

Where are Squamous cell carcinomas more common

A

In places where schistosomiasis is endemic

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9
Q

Whats the risk factor for TCC bladder cancer

A

Smoking (accounts for 40% of cases)

Aromatic amines

Non-hereditary genetic abnormalities (e.g. TSG incl. p53 and Rb)

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10
Q

What the risk factor for SSC in the bladder

A

Schistosomiasis (S. haematobium only)

Chronic cystitis (e.g. recurrent UTI, long term catheter, bladder stone)

Cyclophosphamide therapy

Pelvic radiotherapy

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11
Q

Where are adenocarcinomas found (very rare)

A

The Urachal

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12
Q

What is a urachal

A

A canal in the foetus that drains urine from bladder to belly button

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13
Q

What the presenting symptoms for bladder cancer

A

Painless visible haematuria
Recurrent UTI
Storage bladder symptoms dysuria, frequency, nocturia, urgency +/- urge incontinence bladder pain

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14
Q

What should you suspect if the patient presents with storage bladder symptoms

A

If present, suspect Carcinoma in Situ (CIS)

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15
Q

What is carcinoma in Situ

A

Carcinoma in situ (CIS) is a group of abnormal cells that are found only in the place where they first formed in the body (see left panel). These abnormal cells may become cancer and spread to nearby normal tissue (see right panel).

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16
Q

What investigations should you carry out for bladder cancer

A

Urine culture

Cystourethroscopy

Upper tract imaging

Urine Cytology
- Limited use in Dipstick haematuria
BP and U&E’s

17
Q

What the risk of malignancy if you find Frank haematuria and patient is >50

A

25-35%

18
Q

What the risk of malignancy if you find microscopic haematuria and patient is >50

A

5-10%

19
Q

What investigations should you do if patient has frank haematuria

A

Flexible cystourethroscopy within 2 weeks

Ct urogram & USS

Urine Cytology may also be useful (but not very sensitive nor specific)

20
Q

What investigations should you do if patient has microscopic haematuria

A

Flexible cystourethroscopy within 4-6 weeks

USS

21
Q

What procedures can be used to diagnose the bladder cancer

A

Cystoscopy and endoscopic resection (TURBT)

EUA to assess bladder mass/thickening before and after TURBT

22
Q

What procedures can be used to stage the bladder cancer

A

Cross-sectional imaging (CT, MRI)

Bone scan if symptomatic

CTU for upper tract TCC (2-7% risk over 10 years; higher risk if high grade, stage or multifocal bladder tumours)

23
Q

What is treatment for Low grade non-muscle invasive (i.e. Ta or T1)

A
  • endoscopic resection followed by single instillation of intravesical chemotherapy (mitomycin C) within 24 hours
  • prolonged endoscopic follow up for moderate grade tumours
  • consider prolonged course of intravesical chemotherapy (6 weeks months) for repeated recurrences
24
Q

What is treatment for high grade non-muscle invasive or CIS

A

-very aggressive – 50-80% risk of progression to muscle invasive stage

endoscopic resection alone not sufficient

CIS consider intravesical BCG therapy (maintenance course, weekly for 3 weeks repeated 6 monthly over 3 years)

patients refractory to BCG – need radical surgery

25
Q

What is treatment for Muscle invasive bladder (T2 - T3)

A

neoadjuvant chemotherapy for local (i.e. downstaging) and systemic control; followed by either :

radical radiotherapy and/or;
radical cystoprostatectomy (men) or anterior pelvic exenteration with urethrectomy (women); with extended lymphadenectomy

radical surgery combined with incontinent urinary diversion (i.e. ileal conduit), continent diversion (e.g. bowel pouch with catheterisable stoma) or orthotopic bladder substitution

26
Q

Where is the most common upper tract TCC located

A

Renal pelvis or collecting symptoms

27
Q

Where is the most least common upper tract TCC located

A

Ureter

28
Q

What is usually common for upper tract TCC

A

Tumours are often high-grade and multifocal on one side

29
Q

What are the presenting symptoms of upper tract TCC

A

Frank haematuria

Unilateral ureteric obstruction

Flank or loin pain

30
Q

What are symptoms of nodal or metastatic disease

A

Bone pain
Hypercalcaemia
Lung involvement
Brain involvement

31
Q

What are Diagnostic investigations for upper tract TCC

A

CT-IVU or IVU

Urine cytology

Ureteroscopy and biopsy

32
Q

What is treatment for upper tract TCC

A

Most upper tract TCCs are treated by nephro-ureterectomy

33
Q

Why are upper tract TCC not treated endoscopically or by segmental resection

A

High risk of local recurrence if treated endoscopically or by segmental resection

Difficult to follow up if treated endoscopically

34
Q

What do you do If unfit for nephro-ureterectomy or has bilateral disease with upper tract TCC

A

If unfit for nephro-ureterectomy or has bilateral disease - absolute indication for nephron-sparing endoscopic treatment (i.e. ureteroscopic laser ablation); needs regular surveillance ureteroscopy

35
Q

If uni-focal and low-grade disease

A

Relative indication for endoscopic treatment

36
Q

If endoscopic treatment is used for upper TCC then what should be done

A

In ALL cases, high risk of synchronous and metachronous bladder TCC (40% over 10 years); hence need surveillance cystoscopy

Urinary (13 decks)

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