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