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Y3M - Urology > Bladder Cancer > Flashcards

Flashcards in Bladder Cancer Deck (19)
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1

Epidemiology

Most common tumour of the urinary system

3% of all cancers in the UK

Peak age >80yrs

More common in men than women 3:1

 

Most diagnosed bladder cancers are superficical like Ta, T1 or CIS with a good prognosis

2

Subtypes

TCC (80-90%)

SCC

Adenocarcinoma (rare)

Sarcoma (rare)

3

What can bladder cancers further be classified into?

Non-muscle-invasive bladder cancer where they done penetrate into the deeper layers of the bladder wall.

Muscle-invasive bladder cnacer penetrating into the deeper layesr of the bladder wall

Locally advanced or metastatic bladder cancer spreading beyond the bladder and distally

4

How can the bladder wall be divided anatomically?

Inner lining of the bladder called transitional epithelium

Second layer which is a connective tissue layer called the lamina propria

Third layer is a muscular layer called muscular propria

Fourth layer is fatty connective tissue layer.

They are important when classifying bladder malignancies

5

Risk factors

Smoking

Increasing age

Aromatic hydrocarbons like industrial dyes or rubbers

Schistosomiasis infection

Previous radiation to the pelvis

6

Clinical features

Painless haematuria visible or non-visible.

Recurrent UTIs or LUTS like freq, urgency or feeling of incomplete voiding

 

7

Examination findings

Typically unremarkable

If the bladder cancer obstructs the ureteric orifice, features of ureteric obstruction may be present.

If there is locally advanced disease pelvic pain might present

Metastatic disease weight loss or lethargy might present

8

Bladder cancer staging

TNM with further subtypes

9

Explain the TNM staging in bladder cancer

10

Explain the different T staging

11

Dx

UTI

Renal calculi

Prostate or renal cancer

12

Investigations

Suspected -> Urgent cystoscopy 2 week wait usually done as a flexible cystoscopy.

If a suspicious lesion is identified from an initial cystoscopy, a rigid cystoscopy might be done for more definitive assessment.

Any tumour identified will require biopsy and potential resection via transurethral resection of bladder tumour (TURBT)

Imaging should be done especially for CT staging

Urine cytology can be sent off as well.

13

Management of non-muscle-invasive bladder cancer CIS or T1 tumours.

Typically resected via TURBT as mainstay of management.

If deemed high risk disease adjuvant intravesical therapy like Bacille Calmette-Guerin BCG or Mitomycin C might be used in outpatient setting.

Radical cystectomy might be done in high-risk disease or limited response to initial treatment.

 

Regular surveillance and follow-up via cytology and cystoscopy is essential due to high risk of recurrence

14

Explain Transurethral Resection of Bladder tumours

TURBT involves resection of bladder tissue by diathermy during rigid cystoscopy.

It is usually done under general or regional anaesthesia and a biopsy sample is obtained for assessment of staging.

15

Management of muscle-invasive bladder cancer.

If fit for surgery -> Radical cystectomy leading to complete removal of bladder.

They will often also need neoadjuvant chemotheray with cisplatin combinatino

16

What is needed after radical cystectomy?

Urinary diversion either through

Ileal conduit formation with urine draining via a urostomy

Bladder reconstruction from a segment of small bowel and urine draining urethrally or via catheter.

 

These patients require regular follow-up with CT imaging to monitor local and distant recurrence

17

Management of locally advanced or metastatic bladder cancer

Chemotherapy with either cisplatin-based or carboplatin + gemcitabine-based regime.

Symptomatic relief + specialist advice and input through MDT

Palliative options and care should be discussed

18

Prognosis

High risk of upper urinary tract symptoms and urethral tumours

Superficial disease = 80-90% 5 year survival

Muscle invasive and metastatic disease = 30-60% and 10-15% respectively

19