Flashcards in Genitourinary Deck (378)
How common is bladder cancer?
4th most common in men
8th most common in women
Who is most likely to get bladder cancer?
men in the 80s
What is the mortality of bladder cancer?
Why is an elderly women with UTI symptoms cause suspicion for bladder cancer?
As UTIs are common in the young, and it is rare she has just become sexually active or changing partners
What are risk factors for bladder cancer?
smoking, occupational exposure to carcinogens e.g. rubber, leather, plastics, azo dyes, fishing, exposur to industrial chemicals e.g. phenacetin, cyclophosphamide, schitosomiosis (chronic inflammation), chronic infection
What are the two types of bladder cancer and which is most common?
urothelial - 95%
squamous cell - 5%
What are the clinical features of bladder cancer?
haematuria (usually painless), dysuria, urgency, frequency, flank pain, pain to a metastases
What does grade mean in terms on cancer?
indicator of invasiveness
What does stage mean in terms of cancer?
extent of the cancer
What are the 4 grades of bladder cancer?
Low grade - 70% - recurrence and bleeding
Invasive high grade - 2.5%
Carcinoma in situ - 5% - high rate of progression - poorly differentiated
What investigations should be done in bladder cancer?
urine dipstick, blood tests, flexible cystoscopy, upper tract imaging
What is an advantage and disadvantage of using CT over US?
CT is more detailed but uses more radiation
Why is a transurethral resection used instead of a biopsy in bladder cancer?
To show histological grade and stage
What is the treatment of a non muscle invasive bladder cancer?
resection and intravesical chemotherapy. Use mitmoycin , mmc and BCG
How does MMC work in bladder cancer treatment?
reduces risk of recurrence and causes cell lysis
How does BCG work in bladder cancer treatment?
reduces risk of progression to muscle invasive and upregulates cytokines
What is the treatment of a muscle invasive bladder cancer?
radical surgery of cystoprostatectomy and urethrectomy with neoadjuvant chemotherapy and radical radiotherapy
What is the treatment of a locally advanced bladder cancer?
radical surgery with neoaduvant/adjuvant chemotherapy, radical radiotherapy
What is the difference between adjuvant and neoadjuvant chemo?
adjuvant aims to kill cancer cells and neo adjuvant aims to shrink it before surgery
What is a BCG?
A bacilli Calmette Guerum, which is a bladder installation
What is haematuria and how is it detected?
blood in the urine found by MSSU or dipstick, it is >3RBC/HPF
What is the difference between macroscopic and microscopic haematuria?
macroscopic can be seen and microscopic appears normal
What does a urine dipstick detect?
RBC, free Hb and myoglobin
How sensitive is a urine dipstick for RBC?
97% so many false positives
What is the difference between uniform and dysmorphic in MSSU?
uniform = non glomerular origin
dysmorphic = glomerular origin
If there is RBC and dysmorphic in urine tests, what does this suggest?
a glomerular disease
What does the presence of leucocytes and bacteria in a urine test suggest?
stones of infection
What can cause a false positive blood test?
menstruation and exercise
What does red urine but MSSU negative suggest?
porphyria, rifampicin, beetroot, veg dyes