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Flashcards in FN: Bladder Tumours Deck (20):
1

Bladder Tumours epi

Incidence:1:5000/yr
Sex: M>F = 4:1

2

Bladder Tumours Pathology

Transitional cell carcinomas account for 90%
SCCs: association with schistosomiasis
Adenocarcinoma

3

Bladder Tumours Natural Hx Low-grade Tumours

80%
Non-invasive, generally not life-threatening
High rate of recurrence

4

Bladder Tumours High-grade tumours

20% invasive and life-threatening
High recurrence rates

5

Bladder Tumours RF

Smoking
Amine exposure (rubber industry)
Previous renal TCC
Chronic cystitis
Schistomiasis (SCC)
Urechal remnants (adenocarcinoma) - embryological remnant of communication between umbilicus and bladder
Pelvic irradiation

6

Bladder Tumours PResentation

Painless haematuria
Voiding irritability: dysuria, freqeuncy, uregency
REcurrent UTIs
Retention and obstructive renal failure

7

Bladder Tumours examination

Anaemia
Palpable bladder mass
Palpable liver

8

TNM staging

80% confined to mucosa
20% penetrate muscle (raised mortality)

9

Spread

Local - pelvic structures
Lymph - iliac and para-aortic nodes
Haem - bones, liver and lungs

10

Histological classification

Grade 1: well differentiated
Grade 2: intermediate
Grade 3: poorly differentiated

11

Investigations

Urine: dip (sterile pyuria), cytology
IVU: filling defects
Cystoscopy with biopsy: diagnostic
Bimanual EUA: helps to assess spread
CT/MRI: helps stage

12

Mx

Depends on histological grade and the presence of dissemination

13

Tis, Ta and T1 (superficial)

- 80% of all pts.
- Diathermy via transurethral cystoscopy/TRansurethral resection of bladder tumour
- Itravesicular chemo: mitomycin C
- Intravesicular immunotherapy: BAcille Calmette-Guerin

14

T2, T3 (Invasive)

- Radical cystectomy with ileal conduit is gold standard
- Radiotherpy: worse yrs but preserves bladder - salvage cystectomy can be performed

- Adjuvant chemo e.g. M-VAC
- Neoadjuvant chemo may have a role

15

t4 Mx

Palliative chemo/radiotherapy
Long-term cathererisation
Urinary diversions

16

Complications

Massive bladder haemorrhage
Cystectomy - sexual and urinary malfunction

17

Follow up

Up to 70% of bladder tumours recur therefore intensive f/up is required
History, examination and regular cystoscopy

18

high risk tumours f/up

Every 3mo for 2 yrs, then every 6mo

19

Low-risk tumours f/up @

9 mo then yrly

20

Prognosis

Depends on age and stage

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