Flashcards in Bladder Deck (11)
What are the subtypes of urothelial cancer?
Transitional cell carcinoma (90%)
Squamous cell carcinoma (5%)
Small cell carcinoma
Metastatic (commonly from melanoma or lobular breast)
What are the risk factors for bladder cancer?
Bladder calculi (squamous)
Chronic cystitis (squamous)
What is the clinical presentation of bladder cancer?
Haematuria - painless, gross, throughout micturition
Bladder irritability - frequency, dysuria, urgency
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
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
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
What is management of non muscle invasive bladder cancer?
TURBT followed by intravesical therapy with either mitomycin or BCG depending on risk stratification
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
What is chemotherapy of choice in bladder cancer?
Sensitive to cisplatin
Use combination regimens
MVAC (methotrexate, vinblastine, doxorubicin, cisplatin)
Cis/Gem (cisplatin, gemcitabine)
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