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Oncology > Bladder > Flashcards

Flashcards in Bladder Deck (11):
1

What are the subtypes of urothelial cancer?

Transitional cell carcinoma (90%)
Squamous cell carcinoma (5%)
Adenocarcinoma
Small cell carcinoma
Micropapillary
Metastatic (commonly from melanoma or lobular breast)

2

What are the risk factors for bladder cancer?

Smoking
Dyes
Petro-chemicals
Paints
Arsenic
Radiotherapy
Cyclophosphamide chemotherapy
Bladder calculi (squamous)
Chronic cystitis (squamous)
Schistosomiasis (sqaumous)

3

What is the clinical presentation of bladder cancer?

Haematuria - painless, gross, throughout micturition
Bladder irritability - frequency, dysuria, urgency

4

How do you diagnose bladder cancer?

Cystoscopy is gold standard
Urine cytology (poor sensitivity)
Visualise upper renal tracts - CT or IVP
CT abdo/pelvis, consider CXR or bone scan if high risk

5

What is the staging of bladder cancer?

Stage 1: non muscle invasive (Tis, Ta or T1)
Stage 2: muscle invasive
Stage 3: invades perivesicular tissue +/- pelvic organs
Stage 4: spread to pelvic wall, nodes or distant metastases

6

What is most important risk stratification of bladder cancer staging?

Non muscle invasive vs muscle invasive

Non muscle invasive = low grade, recurs locally
Muscle invasive = high grade, disseminates easily

7

What is management of non muscle invasive bladder cancer?

TURBT followed by intravesical therapy with either mitomycin or BCG depending on risk stratification

8

What is the management of muscle invasive bladder cancer?

Standard of care is neoadjuvant chemotherapy followed by radial cystectomy
Neoadjuvant chemotherapy showed large OS benefit

9

What is chemotherapy of choice in bladder cancer?

Sensitive to cisplatin
Use combination regimens
MVAC (methotrexate, vinblastine, doxorubicin, cisplatin)
Cis/Gem (cisplatin, gemcitabine)

10

What is bladder preservation?

Alternative "curative" options for those unfit for surgery or who decline cystectomy
TURBT followed by radical chemo-radiation with mitomycin and 5-fluorouracil

11

What is the treatment for metastatic bladder cancer?

Standard first line chemotherapy is MVAC or Cis/Gem, if patients can tolerate.
Other options include substituting carboplatin for cisplatin