Bladder Cancer

Question 1

Incidence of Bladder Cancer

Answer 1

◦2-3 times more common in men than women
◦more common in•smokers
•persons ≥ 60 years old
•workers occupationally exposed to bladder carcinogens especially in manufacturing settings
•agricultural workers in countries where schistosomiasis infection is endemic

Question 2

Bladder cancer is more common in

Answer 2

Men than women.

2 to 3 times more common in men and women

Question 3

Th bladder cancer is mostly seen and people greater than

Answer 3

60 years old

Question 4

Occupational risk includes

Answer 4

Being exposed to bladder carcinogens in the manufacturing setting

Question 5

The agricultural workers in countries where________is endemic, have a higher rate of bladder cancer

Answer 5

schistosomiasis infection that

Question 6

What causes bladder cancer?

Answer 6

The etiology of bladder cancer is primarily unknown.

Question 7

Can genetic factors play a part in bladder cancer?

Answer 7

YES.

•genetic factors, such as polymorphisms in◦exact cause unknown, but likely includes combination of

Question 8

Certain exposures are believed to play a part related to bladder cancer. Name some.

Answer 8

•exposure to bladder carcinogens, such as
◦tobacco smoke
◦aromatic amines (beta-naphthylamine)
◦nitrites and nitrates
◦acrolein (propenal)
◦coal
◦arsenic
◦paint
◦aniline dye

Question 9

Name some subjective symptoms of bladder cancer.

Answer 9

Painless hematuria

frequency, urgency and dysuria

Question 10

What are some obstructive symptoms of bladder cancer?

Answer 10

◦obstructive symptoms may occur if tumor near urethra or bladder neck, such as
•decreased force of stream
•intermittent stream
•straining
•feeling of incomplete emptying of bladder

Question 11

What are symptoms of advanced metastatic disease related to bladder cancer?

Answer 11

• flank pain from ureteral obstruction

* abdominal, pelvic, or bone pain from distant metastases

Question 12

But what are objective signs of bladder cancer?

Answer 12

◦early bladder cancer generally without signs on physical exam

Question 13

What are signs of advanced or metastatic disease ?

Answer 13

◦signs of advanced or metastatic disease may include:
palpable suprapubic mass,
 kidney mass
•cachexia
•pallor
•lower extremity edema

Question 14

What are recommended screenings for bladder cancer?

Answer 14

United States Preventive Services Task Force (USPSTF) finds insufficient evidence to assess balance of benefits vs. harms of screening for bladder cancer in asymptomatic adults

Question 15

What is the recommended follow up for bladder cancer?

Non-muscle invasive cancer with low risk of recurrence:

Answer 15

perform cystoscopy at 3 months, and if negative
◦repeat cystoscopy at 9 months after transurethral resection (TUR)
◦then, repeat cystoscopy annually for 5 years

Question 16

What is the recommended follow up for bladder cancer?

Tumors with high risk of progression:

Answer 16

perform cystoscopy and urinary cytology at 3 months, and if negative
◦repeat cystoscopy and urine cytology every 3 months for 2 years, then every 6 months until 5 years, then annually
◦perform imaging of upper urinary tract annually

Question 17

What is the recommended follow up for bladder cancer?

Intermediate risk of progression:

Answer 17

perform follow-up cystoscopy and cytology based on personal and subjective factors

Question 18

What is the recommended follow up for bladder cancer?

positive cytology and no visible tumor in bladder :

Answer 18

◦random biopsy or biopsy with photodynamic diagnosis (fluorescence cystoscopy)
◦investigation of extravesical locations with computed tomography urography or prostatic urethra biopsy

Question 19

What is the recommended follow up for bladder cancer?

After bladder sparing surgery?

Answer 19

perform urine cytology and cystoscopy (with or without biopsy) every 3 months for 1-2 years,
then increase intervals to every 6 months