Bladder Cancer

Question 1

True / False: Bladder cancer is more common in men than women

Answer 1

True - About a 5:2 ratio

Incidence also increases with age, with >80% of cases being diagnosed in patients over 65 years old

Question 2

List some risk factors for developing bladder cancer

Answer 2

Smoking
Age
Male gender
Working with dyes (hairdresser etc)
Radiation
Hydrocarbons (Gas and tar manufacturing industries)
Long-term inflammation e.g. stones
Drugs

Question 3

What is the main clinical presentation of bladder cancer?

Answer 3

Painless visible haematuria

Question 4

What is the most common pathology of bladder cancer?

Answer 4

Over 90% are transitional cell carcinomas

Question 5

True / False: Most bladder cancers have already invaded the bladder muscle at presentation

Answer 5

False - About 75% of bladder cancers present with Tis or T1 tumours i.e. those confined to the bladder mucosa

Question 6

What is the gold standard investigation for bladder cancer?

Answer 6

Cystoscopy and biopsy

Question 7

Where might bladder cancer metastasise to?

Answer 7

Pelvis, lymphatics, liver, lung

Question 8

What should prompt an urgent 2WW referral for possible bladder cancer

Answer 8

• Patient age over 45 and visible haematuria in the absence of infection, or persistent visible haematuria on treatment and clearance of a UTI
• Patient age over 65 and any unexplained non-visible haematuria and either dysuria or raised WCC

Question 9

In the staging system for bladder cancer, which is the first stage which invades through to the bladder muscle?

Answer 9

T2

Question 10

What is the management of low grade non-invasive bladder cancer?

Answer 10

TURBT (Transurethral resection of a bladder tumour) is done during initial cystoscopy
Single-dose adjuvant chemotherapy may also be given
Repeat cystoscopy at 3/12 and 12/12 then discharge

Question 11

What is the management of intermediate risk non-invasive bladder cancer?

Answer 11

TURBT (Transurethral resection of a bladder tumour) is done during initial cystoscopy
Adjuvant chemotherapy course for 6 doses
Follow up cystoscopies until 5 years

Question 12

What is the management of high risk non-invasive bladder cancer?

Answer 12

2 x TURBT procedures
6/52 course of BCG
Annual cystoscopy follow up (more regularly for first 2 years)

Question 13

What is BCG and how is it used in bladder cancer?

Answer 13

Bacillus Calmett-Guerin

An adjuvant treatment which aims to preserve the bladder. It mediates the immune response to decrease risk of recurrence. Administered weekly for 6/52

Question 14

What is the treatment for T2-3 stage bladder cancer?

Answer 14

Radical cystectomy is gold standard. Radiotherapy is also available as it preserves the bladder but outcomes are poorer.
Adjuvant chemotherapy