Bladder Cancer

Question 1

What is the incidence of bladder cancer in the UK?

1 - 1.7 cases per 100,000
2 - 17 cases per 100,000
3 - 170 cases per 100,000
4 - 1700 cases per 100,000

Answer 1

2 - 17 cases per 100,000

Question 2

What age does the incidence of bladder cancer peak?

1 - >70
2 - >60
3 - >50
4 - >40

Answer 2

1 - >70

Question 3

Is bladder cancer more common in men or women?

Answer 3

• men

2.7:1

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
7 - Age

Answer 4

6 - Alcohol

Question 5

All of the following are risk factors for bladder cancer, but which of the following is the biggest risk factor?

1 - Rubber manufacture
2 - Cyclophosphamide (medication used to treat myeloma)
3 - Smoking
4 - Petrochemicals
5 - Hairdressers (aniline dyes)
6 - Chronic bladder inflammation
7 - Schistosomiasis (parasitic worms) in Africa, Asia, S America, Caribbean
8 - Age

Answer 5

8 - Age

Closely followed by Smoking and Petrochemicals

Question 6

Which 2 of the following countries has the highest incidence of bladder cancer?

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

Answer 6

3 - Egypt
5 - Belgium

Question 7

What cell type lines the inside of the bladder?

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

Answer 7

1 - transitional epithelium
Called transitional as they change their shape and structure as the bladder stretches

There are 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 8

There are 3 main types of bladder cancer, which of these is most common, accounting for >90% of cases?

1 - Transitional Cell Carcinoma
2 - Squamous Cell Carcinoma
3 - Adenocarcinoma

Answer 8

1 - Transitional Cell Carcinoma

Question 9

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

Answer 9

• bladder
• accounts for 95% of all cancers

Question 10

There are 3 main types of bladder cancer, with Transitional Cell Carcinoma (TCC) (most common, Squamous Cell Carcinoma and Adenocarcinoma. Which of these typically has the best prognosis as they typically are superficial and do not move through the layers of the bladder?

1 - Transitional Cell Carcinoma
2 - Squamous Cell Carcinoma
3 - Adenocarcinoma

Answer 10

1 - Transitional Cell Carcinoma

Squamous Cell Carcinoma and Adenocarcinoma are more likely to:

• have local invasion
• higher grade
• worse prognosis
• more likely to have regional and distant lymph node metastasis

Question 11

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

Answer 11

• non-invasive muscle accounts for 80%

Question 12

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

Answer 12

• always

Bladder cancer until proven otherwise

Question 13

The following are all common signs of bladder cancer, but which is by far the most common?

1 - dysuria
2 - frequency
3 - haematuria
4 - urgency
5 - suprapubic pain.

Answer 13

3 - haematuria

Can be visible or microscopic

All of these symptoms are typically when the bladder cancer has progressed

Question 14

Haematuria is the most common symptom in bladder cancer. Is this painful or painless?

Answer 14

• typically painless

Question 15

Which of the following is NOT a red flag sign in bladder cancer?

1 - haematuria
2 - weight loss
3 - fatigue
4 - thrombocytopenia
5 - anaemia.

Answer 15

4 - thrombocytopenia

Malignancy typically causes thrombocytosis

Question 16

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 16

2 - >45

Question 17

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 17

4 - >60

Question 18

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 18

2 - ultrasound

Question 19

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 19

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

Question 20

Which of the following is best for looking at local invasion spread of bladder cancer?

1 - ultrasound
2 - CT
3 - MRI
4 - CT-PET

Answer 20

3 - MRI

Question 21

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 21

1 - T3 tumour invades perivescular tissue

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

Question 22

Which of the following definitions is stage T1?

1 - tumour invades perivesicle tissue
2 - tumour invades surrounding tissue
3 - tumour is confined to the inner bladder (carcinoma in situ)
4 - tumour invades the muscle

Answer 22

3 - tumour is confined to the inner bladder (carcinoma in situ)

Question 23

Which of the following definitions is stage T2?

1 - tumour invades perivesicle tissue
2 - tumour invades surrounding tissue
3 - tumour is confined to the inner bladder (carcinoma in situ)
4 - tumour invades the muscle

Answer 23

4 - tumour invades the muscle

Question 24

Which of the following definitions is stage T3?

1 - tumour invades perivesicle tissue
2 - tumour invades surrounding tissue
3 - tumour is confined to the inner bladder (carcinoma in situ)
4 - tumour invades the muscle

Answer 24

1 - tumour invades perivesicle tissue

Question 25

Which of the following definitions is stage T4? 1 - tumour invades perivesicle tissue 2 - tumour invades surrounding organs 3 - tumour is confined to the inner bladder (carcinoma in situ) 4 - tumour invades the muscle

Answer 25

2 - tumour invades surrounding organs

Question 26

If a patient is diagnosed with Non-Muscle Invasive Transitional Cell Carcinoma (TCC) in the bladder and is low risk, how often are they monitored using cystoscopy? 1 - every 3 months only 2 - every 3 and 6 months 3 - every 3 and 12 months 4 - every 12 and 24 months

Answer 26

3 - every 3 and 12 months

Question 27

If a patient is diagnosed with Non-Muscle Invasive Transitional Cell Carcinoma (TCC) in the bladder and is intermediate risk, how often are they monitored using cystoscopy? 1 - every 3 months only 2 - every 3 and 6 months 3 - every 3 and 12 months 4 - every 12 and 24 months

Answer 27

2 - every 3 and 6 months Continued for 3 years and then becomes annual and discharged after 5 years Also given Intravesical mitomycin course x6

Question 28

If a patient is diagnosed with Non-Muscle Invasive Transitional Cell Carcinoma (TCC) in the bladder and is high risk, how often are they monitored using cystoscopy? 1 - every 3 months only 2 - every 3 and 6 months 3 - every 3 and 12 months 4 - every 12 and 24 months

Answer 28

1 - every 3 months only Moves to every 6 months after 3 years May also be given the TB vaccine, Bacillus Calmette–Guérin vaccine This is a Tuberculosis vaccine that can be useful in patients who are at high risk of non-invasive muscle cancer returning

Question 29

What is the 1st line treatment of choice for non-invasive (T1 N0 M0) Transitional Cell Carcinoma of the bladder and ureter? 1 - Radical cystectomy 2 - Chemotherapy and 3 - Radiotherapy 4 - Cystoscopy and transurethral resection (TURBT)

Answer 29

4 - Cystoscopy and transurethral resection (TURBT) TURBT = trans urethral resection of bladder tumour Intravesical chemotherapy is typically given after TURBT - low risk = 3 and 12 months - med risk = 3, 6 and 12 months - high risk = every 3 months

Question 30

In patients who have had a Cystoscopy and transurethral resection (TURBT) procedure, what can they be given that causes inflammation and shedding of the epithelial cells of the bladder, including the tumour? 1 - Hepatitis B 2 - Bacillus Calmette–Guérin vaccine 3 - Epstein Barr virus 4 - Varicella-zoster virus

Answer 30

2 - Bacillus Calmette–Guérin vaccine This is a Tuberculosis vaccine Can be useful in patients who are at high risk of non-invasive muscle cancer returning

Question 31

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 31

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

Question 32

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

Answer 32

Neoadjuvant chemotherapy: Cisplatin-based combination chemotherapy is recommended before radical cystectomy for eligible patients. Radical cystectomy: Complete surgical removal of the bladder, prostate or uterus, and regional lymph nodes. Urinary diversion options include ileal conduit, continent cutaneous reservoir, or orthotopic neobladder. Bladder-sparing approaches: For select patients, a multimodal approach combining maximal TURBT, radiotherapy, and chemotherapy may be considered. Adjuvant chemotherapy: May be considered for patients with high-risk features following cystectomy or bladder-sparing treatment.

Question 33

62 year old male who works as a mechanic presents to practice nurse with a potential UTI and painless haematuria for 2 weeks. He smokes and is urinating more often. Which of the following would be the best method to confirm a diagnosis? 1 - ultrasound 2 - MRI 3 - cystoscopy 4 - CT scan

Answer 33

3 - cystoscopy Allows imaging and biopsy

Question 34

If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count? 1 -dexamethasone 2 - granulocyte colony stimulating factors (GCSF) 3 - blood transfusion 4 - frozen WBCs

Answer 34

2 - granulocyte colony stimulating factors (GCSF)