Urothelial Carcinoma Flashcards
another name for urothelial carcinoma
transistional cell carcinoma
investigations of frank haematuria
flexible cystourethroscopy, CT, USS
investigations of dipstick or microscopic haematuria
flexible cystourethroscopy and USS, but needed less urgently than in frank haematuria
risk of malignancy in over 50 y/o with dipstick or microscopic haematuria
5-10%
which type of haematuria has a greater risk of malignancy in over 50 y/o
frank
what is the most common neoplastic cause of haematuria
bladder TCC
what is an IVU
an intravenous urogram (aka intravenous pyelogram). injected with special contrast to show up kidneys and tract on an X-ray
problem with IVU and USS for diagnosing TCC
they miss a proportion of tumours
what risk factor is present in 40% of bladder TCC
smoking
risk factors of bladder TCC
smoking, aromatic amines?and non-hereditary genetic mutations in p53 and Rb
what parasite is a risk factor for squamous cell bladder cancer
schistosomiasis haematobium
what is cyclophosphamide therapy
chemotherapy
risk factors for squamous cell carcinoma
schistomiasis chronic cystitis chyclophosphamide pelvic radiotherapy adenocarcinoma
presentation of bladder cancer
haematuria (frank or microscopic) recurrent UTI storage LUTS bladder pain metastatic symptoms
investigations when presentation is haematuria
urine culture, urine cytology, cystourethroscopy and CTU/USS
what is CIS
carcinoma in situ: a very aggressive non-invasive tumour
what T grade is a tumour in the mucosal layer of the bladder
T1
what grades represent a tumour that has invaded the muscle wall and no further
stages 2 and 3
where does a T4 bladder TCC tumour invade to
outside bladder: prostate, vagina, uterus
what does M1 mean
the tumour has distant metastases
what does N0 mean
no lymph node spread
what does N1 mean
one regional lymph node spread
what does N2 mean
multiple lymph node spread in pelivs
risk of bladder TCC in frank haematuria in >50y/o
25-35%
what proportion of TCC are bladder
90%
treatment in T1 bladder TCC
endoscopic resection + intravesical chemo –> endoscopic check up –> further course of chemo
treatment in T2 bladder TCC
bacillus calmette-guerin chemo weekly –> radical cystectomy if refractory to BCG
treatment in T2-T3 bladder TCC
neoadjuvant chemo followed by –> radical radiotherapy
OR
–> radical cystectomy (with prostate in men/with urethra in women)
5 year survival for invasive high grade bladder TCC
50%
5 year survival for non-invasive low grade bladder TCC
90%
what is UTUC
upper tract urothelial carcinoma
where does UTUC most commonly occur
in the collecting system or renal pelvis
mainstay of treatment in high grade UTUC
nephro-ureterectomy
why is an endoscopic resection no use in high grade UTUC
because there is a high recurrence rate
presentation of UTUC
frank haematuria, flank pain, symptoms of metastases, unilateral ureteric obstruction
4 investigations to order in UTUC
CT-IVU/IVU
urine cytology
ureteroscopy
biopsy
what is the main prognostic risk of UTUC
developing bladder TCC (40% in 10 years)
what differs between presentation of bladder TCC and UTUC
bladder has recurrent UTIs and storage LUTS; UTUC does not
symptoms of UTUC present unilaterally i.e flank pain; bladder does not
