Bladder cancer

Question 1

Epidemiology

Answer 1

11th most common cancer
90% are transitional cell carcinoma

Question 2

RFs: TCC

Answer 2

Smoking
Aromatic amines (rubber, dyes and chemical industry)
Cyclophosphamide

Question 3

RFs: squamous cell carcinoma

Answer 3

Schistosomiasis infection
Long term catheterisation (10+ years)
Renal calculi

Question 4

RFs: adenocarcinoma

Answer 4

Other types bladder cancer
Local bowel cancer

Question 5

Features
1. Local
2. Systemic

Answer 5

Visible haematuria is bladder cancer until proven otherwise.

1. Painless haematuria
   UTIs
   Hydronephrosis

Bladder cancer can invade adjacent structures such as the obturator nerve, causing neuropathic pain on the medial thigh.

2. Weight loss
   Night sweats

Question 6

Metastasis

Answer 6

Lung
Liver
Bone

Question 7

Investigations

Answer 7

Bedside: urine dip for haematuria
Can send urine to check for haematuria

Imaging
1. CT Urogram - identifies filling defects
2. Flexible cystoscopy - rigid cystoscopy can take biopsy

Question 8

Mx: non-muscle invasive (CIS, Ta and T1)

Answer 8

1. Surgery = Transurethral resection of the bladder tumour (TURBT)
2. Chemotherapy (Mitomycin C) at TURBT or at weekly intervals following a TURBT.

Question 9

Mx: muscle invasive (T2 and above)

Answer 9

If no significant comorbidities and/or metastasis – cystectomy with urinary diversion

Question 10

Options for urinary diversion

Answer 10

Ileal conduit
Neo-bladder

Question 11

Mx: non-surgical of muscle invasive

Answer 11

Radiotherapy:
Chemotherapy: