Bladder

Question 1

What is the peak age for bladder cancer?

Answer 1

70 years or older (peak age of 73)

Question 2

What is the male to female ratio for bladder cancer?

Answer 2

Approximately 4:1

Question 3

Which racial group is more likely to develop bladder cancer?

Answer 3

Caucasian Americans are two times more likely than African Americans

Question 4

What is the most important risk factor for bladder cancer?

Answer 4

Smoking

Question 5

How much more likely are smokers to develop bladder cancer compared to non-smokers?

Answer 5

At least 3 times as likely

Question 6

What percentage of bladder cancer patients experience gross painless hematuria?

Answer 6

75-80%

Question 7

What is gross hematuria?

Answer 7

Visible blood in urine that turns red.

Question 8

What is microscopic hematuria?

Answer 8

Blood in urine that may not be seen with the naked eye.

Question 9

What are common symptoms of bladder cancer?

Answer 9

Blood in urine, urgency, and dysuria.

Question 10

What is included in the complete history and physical exam (H&P)?

Answer 10

It includes a rectal and pelvic exam.

Question 11

What imaging is performed in the diagnostic workup?

Answer 11

A chest X-ray (CXR) is performed.

Question 12

What tests are included in the diagnostic workup for males?

Answer 12

CXR and urinalysis.

Question 13

What areas are examined in the male diagnostic workup?

Answer 13

Urethra, prostate, and bladder.

Question 14

What blood tests are included in the diagnostic workup?

Answer 14

Complete blood count (CBC) and liver function test.

Question 15

What procedure is done for diagnosis?

Answer 15

Cystoscopy.

Question 16

What is the purpose of a biopsy in the diagnostic workup?

Answer 16

It is done for diagnosis.

Question 17

What fluid is involved in the cystoscopy procedure?

Answer 17

Fluid filling the bladder.

Question 18

What anatomical areas are relevant in the female diagnostic workup?

Answer 18

Uterus, vagina, anus, and rectum.

Question 19

What type of cancer is mentioned in the diagnostic workup?

Answer 19

Bladder cancer.

Question 20

What are the three major types of bladder cancer?

Answer 20

1. Transitional cell carcinoma (Urothelial carcinoma)
2. Squamous cell carcinomas
3. Adenocarcinomas

Question 21

Which type of bladder cancer is the most common?

Answer 21

Transitional cell carcinoma (Urothelial carcinoma) is by far the most common type of bladder cancer.

Question 22

Where do most bladder cancers start?

Answer 22

Most bladder cancers start in the innermost lining of the bladder, called the urothelium or transitional epithelium.

Question 23

What happens as bladder cancer grows into or through the bladder wall layers?

Answer 23

As the cancer grows into or through the other layers in the bladder wall, it has a higher stage, becomes more advanced, and can be harder to treat.

Question 24

What are the routes of spread for bladder cancer?

Answer 24

Lymphatic drainage to: External iliac, Internal iliac, Presacral lymph nodes

Question 25

What is the main advantage of Partial Cystectomy?

Answer 25

The person keeps their bladder and doesn't need reconstructive surgery.

Question 26

What is a Cystectomy?

Answer 26

A surgical operation that removes all or part of the bladder, depending on the stage of cancer.

Question 27

What does Radical Cystectomy involve?

Answer 27

It removes the entire bladder and nearby lymph nodes, as well as the prostate and seminal vesicles in men, and the ovaries, fallopian tubes, uterus, cervix, and a small part of the vagina in women.

Question 28

What is Bacillus Calmette-Guerin (BCG)?

Answer 28

The most common intravesical immunotherapy for treating early-stage bladder cancer.

Question 29

How is BCG administered?

Answer 29

Through intravesical therapy, where the doctor puts a liquid drug directly into the bladder.

Question 30

What are common chemotherapy drugs used with radiation for bladder cancer?

Answer 30

Cisplatin, Cisplatin plus fluorouracil (5-FU), and Mitomycin with 5-FU.

Question 31

What position is the patient in during bladder setup for simulation?

Answer 31

The patient is in the supine position.

Question 32

What is inserted into the bladder during the setup?

Answer 32

A Foley catheter is inserted into the bladder using sterile technique.

Question 33

What is injected into the bladder to outline its posterior portion?

Answer 33

Iodinated contrast is injected.

Question 34

What is the preferred bladder state during scanning and treatment?

Answer 34

Scan bladder FULL, but treat bladder EMPTY.

Question 35

Why is daily CBCT imaging used in bladder cancer treatment?

Answer 35

To reduce the field size from 2 to 3 cm down to 1 to 1.6 cm and significantly reduce radiation-induced complications.

Question 36

What is the typical radiation treatment dose for the larger pelvic field including the bladder and pelvic lymph nodes?

Answer 36

The typical dose is 45 to 50 Gray at 180 cGy per day.

Question 37

What is the preoperative radiation dose for bladder cancer?

Answer 37

The preoperative dose is 45-50 Gy at 1.8 Gy/fraction.

Question 38

What is the postoperative radiation dose for bladder cancer?

Answer 38

The postoperative dose is 65-70 Gy at 1.8 Gy/fraction.

Question 39

What is the radiation dose for combined EBRT and chemotherapy?

Answer 39

The dose for EBRT and chemotherapy is 45-65 Gy at 1.8 Gy/fraction.