Bladder cancer Flashcards
Risk factors
Smoking and increased age are main risks
Aromatic amines (dye and rubber)
Schistosomiasis causes squamous cell carcinoma
Types
Transitional cell (urothelial) carcinoma most common
Squamous cell carcinoma
TNM staging
Non-invasive: Tis, Ta, T1
Invasive: T2-4 and any lymph node or metastatic spread
Presentation
Painless haematuria
2 week wait
Aged >45 with unexplained visible haematuria
Aged >60 with microscopic haematuria and dysuria/ raised WCC
Diagnosis
Cystoscopy to visualise bladder
Biopsies
Treatment
Transurethral resection of bladder tumour
Intravesical chemotherapy
Intravesical BCG
Radical cystectomy
TURBT
Remove bladder tumour during cystoscopy procedure
Intravesicle chemotherapy
Chemotherapy given into the bladder through a catheter
Often used after a TURBT to reduce risk of recurrence
Intravesicle BCG
Form of immunotherapy
Stimulate immune system which attacks the bladder tumour
Radical cystectomy
Removal of entire bladder
Several options to drain urine
- urostomy with an ileal conduit
- continent urinary diversion
- neobladder reconstruction
- uterosigmoidoscopy
Ileal conduit
Section of ileum is removed and end-to-end anastomosis is created so bowel is continuous
Ends of ureters anastomsed to separated section of ileum
Other end forms stoma on the skin draining into urostomy
Continent urinary diversion
Pouch inside the abdomen from a section of the ileum with the ureters connected
Pouch fills with urine
Thin tube connected between stoma on skin and internal pouch
Patient needs to intermittently self-catheterise
Neobladder reconstruction
Create a new bladder from a section of the ileum
Connected to both ureters and the urethra and functions similarly to a normal bladder
May require intermittent catheterisation and bladder washouts to clear secretions from the small bowel tissue
Uterosigmoidostomy
Attaching ureters directly to sigmoid colon
Urine drains into and collects the sigmoid colon
Create pouch for urine to collect
Rarely done now as associated with infection in the kidneys, electrolyte imbalance and secondary cancer
