Disease - Bladder cancer

From CambridgeNotes

1/5000 people per year; typically affects older patients; M>F
Aetiology: smoking, schistosomiasis, stones
Pathology: transitional cell carcinoma (TCC) > squamous cell carcinoma (SCC) > adenocarcinoma

History and Examination

  • Painless haematuria (90%); recurrent urinary tract infection (UTI)

Differential Diagnosis

  • Haemorrhagic cystitis, UTI, stones

Investigations

  • Urine culture, microscopy and cytology
  • FBC, U&E, LFT; Cystoscopy and biopsy
  • Staging: chest X-ray, CT, and possibly MRI or bone scan

Treatment

  • Depends on stage (TNM):
    • Ta – confined to mucosa
    • T1 – invades lamina propria
    • T2 – muscle involved
    • T3 – perivesical fat involved
    • T4 – invasion beyond bladder
  • Superficial (Ta, T1): usually exophytic papillary TCCs (15% progress to invasive in 10 years); perform cystoscopy and resection; consider intravesical chemotherapy
  • Invasive (T2, T3): radical radiotherapy or radical cystectomy with formation of ileal conduit or neobladder out of small bowel
  • T4: treat symptoms e.g. cystectomy
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