Bladder Cancer

Question 1

What cell type lines the inside of the bladder?

1 - transitional epithelium
2 - stratified columnar
3 - stratified cuboidal
4 - pseudocolumnar

Answer 1

1 - transitional epithelium
- has 3 types of cell layers:

• basal, intermediate, superficial
• basal layer fosters the epithelial stem cells in order to provide constant renewal of the epithelium
• most impermeable membrane in the body due to highly keratinized cellular membrane

Question 2

Transitional Cell Carcinoma of the Bladder and Ureter is the 10th most common cancer in the world affecting men slightly more, peaking at age 65. Which 2 of the following countries have the highest incidence from the following?

1 - Uk
2 - Finland
3 - Egypt
4 - Spain
5 - Belgium

Answer 2

3 - Egypt
5 - Belgium

Question 3

Is Transitional Cell Carcinoma of the Bladder or Ureters more common?

Answer 3

• bladder
• accounts for 95% of all cancers

Question 4

Which of the following is NOT a typical risk factor for Transitional Cell Carcinoma of the Bladder and Ureters?

1 - Smoking 50%
2 - Petrochemicals
3 - Hairdressers (due to dye)
4 - Chronic bladder inflammation
5 - Schistosomiasis (parasitic worms)
6 - Alcohol

Answer 4

6 - Alcohol

Question 5

Transitional Cell Carcinoma of the bladder and ureter can be muscle invasive or non-invasive. Which is more common?

Answer 5

• non-invasive muscle accounts for 80%

Question 6

If a patient presents with haematuria, should we always consider Transitional Cell Carcinoma of the bladder and ureter?

Answer 6

• always
• consider cancer until it has been ruled out

Question 7

According to NICE guidelines if a patient presents to the GP with:

• unexplained visible haematuria
• without a UTI or persisting after treatment for a UTI, what age do they need to be to be referred on the 2 week wait?

1 - >35
2 - >45
3 - >55
4 - >65

Answer 7

2 - >45

Question 8

According to NICE guidelines if a patient presents to the GP with:

• microscopic haematuria (not visible but positive on a urine dipstick)
• dysuria (painful urinating) or;
• raised WBC on a FBC

What age do they need to be for a 2 week referral?

1 - >30
2 - >40
3 - >50
4 - >60

Answer 8

4 - >60

Question 9

What is often the 1st line imaging in a patient with suspected Transitional Cell Carcinoma of the bladder and ureter?

1 - CT KUB
2 - ultrasound
3 - MRI-FDG
4 - chest-abdo and pelvic X-ray

Answer 9

2 - ultrasound

Question 10

Once an ultrasound has been performed, what is the imaging of choice to diagnose a patient with Transitional Cell Carcinoma of the bladder and ureter?

1 - CT KUB
2 - cystoscopy
3 - MRI-FDG
4 - chest-abdo and pelvic X-ray

Answer 10

2 - cystoscopy
- can also be used to take a biopsy and perform histology

Question 11

CT-PET is used to stage Transitional Cell Carcinoma of the bladder and ureter. Which of the following stages does NOT come under the heading of non-invasive bladder cancer?

1 - T3 tumour invades perivescular tissue
2 - carcinoma in situ: cancer cells only affect the urothelium and are flat
3 - Ta: cancer only affecting the urothelium and projecting into the bladder
3 - T1: cancer invading the connective tissue layer beyond the urothelium, but not the muscle layer

Answer 11

1 - T3 tumour invades perivescular tissue

• > T2 is muscle invasive bladder cancer and any lymph node and metastatic cancer

Question 12

What is the 1st line treatment of choice for non-invasive Transitional Cell Carcinoma of the bladder and ureter?

1 - Radical cystectomy
2 - Chemotherapy and
3 - Radiotherapy
4 - Cystoscopy and transurethral resection (TURBT)

Answer 12

4 - Cystoscopy and transurethral resection (TURBT)
- Intravesical chemotherapy can be used after TURBT

• low risk = 3 and 12 months
• med risk = 3, 6 and 12 months
• high risk = every 3 months

Question 13

In patients who have had a Cystoscopy and transurethral resection (TURBT) procedure, what

1 - Hepatitis B
2 - Bacillus Calmette–Guérin vaccine
3 - Epstein Barr virus
4 - Varicella-zoster virus

Answer 13

2 - Bacillus Calmette–Guérin vaccine

• can be useful in patients who are at high risk of non-invasive muscle cancer returning

Question 14

In patients who have been confirmed as having muscle invasive bladder cancer, what imaging is used to stage the cancer?

1 - CT-KUB
2 - CT-CAP
3 - MRI with contrast
4 - cystoscopy

Answer 14

2 - CT-CAP
- CAP = chest, abdo and pelvis
- MRI, PET scan and bone scan can also be performed to look for metastasis

Question 15

In a patient with muscle invasive bladder carcinoma, there are a myriad of treatments available:

• Neoadjuvant chemotherapy such as Gemcitabine and Cisplatin
• Cystectomy (bladder removal) with an Ileal conduit or Neobladder
• Radiotherapy

Metastatic Disease includes:
- Supportive care
- Chemotherapy
- Palliative (haemostatic) - radiotherapy