Bladder Cancer

Types

  • 90% transitional cell carcinoma
  • 10 % squamous cell carcinomas
  • Rarer causes are adenocarcinoma, sarcoma, small cell.

 

Facts

  • They arise from the endothelial lining (urothelium)
  • The typical presentation is painless haematuria
    • Typical exam question is a “dye factory worker with painless haematuria”
  • Diagnosed by cystoscopy and biopsy
  • The majority are superficial (not invading the muscle) at presentation
  • Staged by the TNM system

 

Associations

  • Smoking
  • There are key workplace carcinomas that are risk factors
    • Carcinogens include aromatic amines, polycyclic aromatic hydrocarbons, arsenic and tetrachloroethylene
    • These are found in hair dyes, industrial paint, rubber, motor, leather, and rubber workers, blacksmiths etc.
  • Schistosomiasis causes squamous cell carcinoma in countries with a high prevalence
  • Drinking sufficient water is thought to be protective

 

Treatment options

  • Not invading the muscle
    • Transurethral Resection of a Bladder Tumour (TURBT)
    • Chemo into bladder after surgery (use barrier contraception afterwards)
    • Weekly treatments for 6 weeks with BCG vaccine squirted into the bladder via catheter, then every six months for 3 years.
  • Muscle-invasive bladder cancer
    • Radical cystectomy with ileal conduit
    • Radiotherapy (as neoadjuvant, primary treatment or palliative)
    • IV chemotherapy as neoadjuvant or palliative
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