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
