Bladder Cancer

Question 1

What is Bladder Cancer?

Answer 1

Malignancy of bladder cells

Question 2

Describe the histological grading of bladder cancer

Answer 2

Grade 1: differentiated
Grade 2: intermediate
Grade 3: poorly differentiated

Question 3

Describe the aetiology of bladder cancer

Answer 3

UNKNOWN

80% are confined to bladder mucosa, only ~20% penetrate muscle

Question 4

Describe the epidemiology of bladder cancer

Answer 4

2% of cancers
2nd most common cancer of the genitourinary tract
M > F
Peak incidence: 50-70 yrs

Question 5

List 7 risk factors for bladder cancer

Answer 5

FHx
Smoking
Aromatic amines: rubber industry, dye stuffs (naphthylamines + benzidine)
Chronic cystitis
Chemo (cyclophosphamide tx)
Pelvic irradiation
Schistosomiasis: inc risk of squamous cell carcinoma

Question 6

List 4 symptoms of bladder cancer

Answer 6

Painless macroscopic haematuria
Irritative/ storage symptoms
Recurrent UTIs
Rarely: ureteral obstruction

Question 7

Describe signs of bladder cancer

Answer 7

Often NO SIGNS
Significant weight loss
Bimanual examination may be performed as part of disease staging

Question 8

Describe what may be seen in urinalysis in bladder cancer

Answer 8

Haematuria

Possibly sterile pyuria

Question 9

What other investigations are used in bladder cancer?

Answer 9

Cystoscopy: for visualisation, biopsy or removal
US: visualisation
CT/ MRI for staging
Urinary tumour markers: BTA, NMP22

Question 10

What is a common complication of bladder cancer? How is this managed?

Answer 10

Hydronephrosis (dilated ureter) is common with cervical, ovarian + bladder cancers
Obstruction will need to be stented

Question 11

In which patients is a 2WW referral for suspected bladder cancer appropriate?

Answer 11

> 45 with unexplained visible haematuria

Non-visible haematuria (on dip) + >60 + not UTI

Question 12

List 5 irritative/ storage symptoms seen in bladder cancer

Answer 12

Frequency 
Urgency 
Nocturia 
Voiding irritability  
Dysuria

Question 13

What cell types are usually involved in bladder cancer?

Answer 13

Most bladder cancers are transitional cell carcinomas (90%)

Transitional epithelia is a form of stratified epithelia

Question 14

What cell types may rarely be involved in bladder cancer? What are these associated with?

Answer 14

Squamous cell carcinomas

associated with chronic inflammation (e.g. schistosomiasis)

Question 15

What investigation is diagnostic of bladder cancer?

Answer 15

Cystoscopy + biopsy