Bladder CA

Question 1

epi of bladder

Answer 1

common

• M>F
• 90% are urothelial carcinoma

Question 2

risk for bladder

Answer 2

• smoking !!1
• occupational exposures
• chinese herbs

Question 3

presentation of bladder CA

Answer 3

1. hematuria - most common
   - gross or microscopic
2. pain
3. LUTS
4. constitutional Sx

Question 4

4 types of tests for Dx

Answer 4

1. urine tests
   - routine microscopy
   - C+S
   - cytology
2. imaging
3. cystoscopy
4. biopsy

Question 5

what is imaging of choice

Answer 5

CT uroscpoy

• comprehensive evaluation of bladder and upper urinary tract
• multiphase aquisition

Question 6

3 parts of multiphase aquisition

Answer 6

1. pre-contrast - look normal
2. 120secs - look for renal
3. 20mins - look at bladder etc

Question 7

what is role of MRI

Answer 7

limited

- onlt for those that can’t CT

Question 8

what is urine cytology

Answer 8

• look for cells sloughing off
• pathologist skill dependent
• low sens, high spec

Question 9

what is stage based on

Answer 9

T - based on TURBT

NM - imaging

Question 10

most important part of T

Answer 10

past the muscularis

Question 11

2 main types

Answer 11

1. non-invasive - 70%
   - low risk of mets, high risk of recurrence
2. muscle invasive
   - high risk of death, mets

Question 12

mgmt of non-invasive

Answer 12

• TURBT
• single dose of intravesicle chemo
• surveillance cysto
• immunotherap - BCG
• chemo

Question 13

mgmt of muscle invasive

Answer 13

take out bladder and everything around it + LN

• ileal conduit
• neobladder