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Flashcards in Renal cancer Deck (12):
1

Bladder cancer risk factors 

  • Age – rare
  • Race- more common in caucasians
  • Environmental Carcinogens
  • Chronic inflammation- stones, infection (schistosamiasis), long term catheters
  • Drugs- phenacitin, cyclophosphamide
  • Pelvic radiotherapy
  • Occupation
  • smokers - 30-50% of all bladder cancer 
  • Due to dyes- aromatic hydrocarbons 

2

Bladder cancer epidemiology 

 

  • Male:female   2.5:1
  • More common in the elderly
     

3

Presentation of bladder cancer 

  • Painless haematuria - 25% serious cause for this in over 65s
  • Even microscopic haematuria - (5% serious causes)
  • All haematuria needs to be investigated with cystoscopy
  • UTIs 
  • pneumaturia 
  • metastic syndromes 

4

Pathology of renal cancer 

  • Transitional cell carcinoma 90%, ¾ is superficial and ¼ invasive
  • Squamous-> 5% - radiation or chronic inflammation
  • Adenocarcinoma -->2% -appears at the dome of the bladder
  • Secondaries

5

Grading of bladder cancer 

  • Cellular system
  • Grade1: Well differentiated – good prognosis
  • Grade 2: Moderately differentiated
  • Grade 3: Poorly differentiatedàleast likely and more likely to progress to invasive disease
  • Carcinoma in situ-actually a poor prognostic sign as it is likely to advance

6

Staging of bladder cancer 

TMN classification used

  • Tis-in situ
  • Ta- not beyond the lamina propria.
  • T1-invaded into lamina propria but not muscularis propria
  • T2-into the muscle
  • T3a-into the fat/serosal
  • T3b-beyond and into adventitia connective tissue
  • T4a-prostate/vagina/uterus
  • T4b-bony pelvis
  • Also N & M

A image thumb
8

Treatment of bladder cancer 

  • Diagnosed in one stop haematuria clinic
  • Receive flexible cystoscopy
  • Referred for urgent Trans-urethral resection of bladder tumour
  • CT IVU- imaging of upper tract as it is very common for there to be transitional cancer affecting the upper urinary tract - (5% chance upper tract involvement)

9

Superficiial TCC 

  • Good prognosis and low risk of progression
  • H/E flexible check cystoscopy is required at 3 months as there is a 50% chance of recurrence
  • Given 6 weeks mitomycin-C (catheterised Chemotherapy) for persistent Ta tumours

10

T1 cis 

  • 50% chance of progression to muscle invasive disease and commonly the cancers reoccur
  • Do early cystoscopy and re-biopsy
  • Treat with Intravesical BCG immunotherapy -6 week’s course and then 2 year maintenance – this is effective in 50%. Then further cystoscopy and re-biopsy
  • Cystectomy if it fails

11

Invasive TCC (T2-4)

  • Require radical cystectomy or radiotherapy (poor if multifocal disease or widespread CIS)àif unfit radiotherapy is better
  • No evidence for one over the other
  • Radiotherapy poor if multifocal disease or widespread CIS
  • Adjuvant chemotherapy

12

Radical cystectomy 

  • Bladder and prostate/uterus removed
  • Urine diverted into an ileal conduit/urostomy. Or an orthothopic neobladder(rare)
  • Complex surgery, mortality 2%
  • Sometimes required after failed radiotherapyàsalvage cystectomy

13

Metastatic disease 

  • Uncommon, most commonly site lymph nodes, chest, liver, bones – always need CXR
  • Chemotherapy
    • M-VAV- methotrexate, vinblastine, doxorubicin, cisplatin
    • Highly toxic