Bladder Cancer

Question 1

RF for bladder cancer?

Answer 1

1. Smoking
2. Chemical exposure
3. Chronic cystitis
4. Chronic UTI
5. Chronic stones
6. Bilharzia
7. Indwelling cath
8. Cyclophosphamide
9. Radiation

Question 2

Mention some precancerous lesions for bladder cancer

Answer 2

1. Sq. Metaplasia : SCC
2. Leukoplakia: SCC
3. Cystitis glandularis : adenocarcinoma
4. Nephrogenic adenoma : adenocarcinoma
5. Dysplasia :TCC / CIS

Question 3

What is the presentation of bladder cancer

Answer 3

Malignant cystitis syndrome

1. Irritative bladder symp. (FUN)
2. Hematuria (painless ) : most common symptom
3. Necroturia
4. Symptoms of mets

Question 4

How to reach diagnosis for bladder cancer?

Answer 4

1. DRE (bimanual exam.)
2. Cystoscopy & biopsy
3. Others :
   IVP filling defect
   CT , MRI
   US
   Routine lab
4. Invest for mets
5. Assess for fitness for surgery

Question 5

Ttt for bladder cancer ?

Answer 5

1. Superficial bladder cancer (NMIC):

Ta /T1 : TURBC / intravesical chemo or radio / BCG (for high grade & risk)

Tis:BCG

2. MIC:
   T2 & T3: radical cystectomy + urinary diversion
   T4 & mets: (palliative)
   Radio or chemo or surgery or combination(trimodal)

Question 6

What are the complications of diversion?

Answer 6

1. Hyperchloremic metabolic acidosis
2. Urinary obstruction / infec /stone form / RF
3. Nutritional deficit & malabsorption
4. Stomal problems
5. Adenocarcinoma of colon