Bladder Cancer

Question 1

What is the most common type of bladder cancer?

Answer 1

Transitional cell carcinoma- arising from the epithelial cells that line the bladder

Question 2

What is the biggest risk factor for developing bladder cancer?

Answer 2

Smoking

Question 3

How can the types of bladder cancer be divided?

Answer 3

Urothelial type- TCC

Non-Urothelial Type= Subdivided as epithelial (SCC, Adenocarcinoma and non-epithelial (sarcoma, melanoma, lymphoma)

Question 4

What are some risk factors for developing bladder cancer?

Answer 4

Increasing age
Smoking
Exposure to industrial chemicals- e.g. metal painters, rubber workers, leather industry, also firefighters
Decreased fluid intake (increases the concentration of carcinogens in urine)
Indwelling catheters
Chronic cystitis
Family history
Previous radiotherapy- e.g. to ovarian or prostate carcinomas

Question 5

What are some symptoms of bladder cancer?

Answer 5

Haematuria
Frequency
Urgency
Incontinence
Passing small volumes of urine
Not feeling like fully emptied bladder
Difficulty urination
Poor stream
Post micturition dribble
Recurrent UTIs do to urinary stasis

Question 6

What are the investigations for someone presenting with suspected bladder cancer?

Answer 6

Urinalysis- Haematuria (addition of proteinuria may indicate nephritic cause)

Examine- Palpate and percuss bladder

DRE may be indicated/ Bimanual examination in women

Gold Standard- Refer for flexible cystoscopy to visualise the inside of the bladder.

Note may also consider- Fluid intake and output charts, urodynamic studies, if BPH considered IPSS score

CT/MRI is done for staging

Question 7

What must be done for staging of bladder cancer?

Answer 7

Tumour biopsy- obtained via cystoscopy

CT/MRI to assess for metastatic disease

Question 8

What are the NICE guidelines for suspected bladder cancer?

Answer 8

Refer urgently if:
45 with visible haematuria
45 with persistent non-visible haematuria after treatment for UTI
60 with non-invisible haematuria and either dysuria or raised WCC

Non urgently if recurrent or persistent UTI in over 60

Question 9

What are the treatment options for bladder cancer?

Answer 9

Localised Disease

• Rigid cystoscopy and surgical excision (TURBT)
• Intravesical BCG/Chemotherapy
• Cystectomy

Advanced disease

• Radical cystectomy (removed surrounding structures)
• Systemic chemotherapy
• Radiotherapy