Bladder Cancer

Main types of Bladder Cancer

1. Transitional cell carcinoma (TCC) – most common worldwide
2. Squamous cell carcinoma(SCC) – chronic inflammation
3. Others – adenocarcinoma, malignant melanoma

Risk factors

1. Rubber exposure
2. Smoking
3. Chronic bladder inflammation. Causes are
   • Long term catheterization
   • Schistosomiasis
   • Bladder stones

Clinical presentation

1. Total hematuria, painless
2. Irritative and obstructive voiding symptoms
3. Constitutional symptoms
4. Pain

Investigations

1. Urinalysis – looks for hematuria
2. Cystoscopy – the gold standard
3. Urine cytology – to look for malignant cells
4. CT urogram – to rule out other causes of hematuria
5. CT scan and bone scan for staging

Grading

1. Well-differentiated
2. Moderately differentiated
3. Poorly differentiated

Staging -TNM

Management

1. Supportive- analgesia, blood transfusion, nutrition, end-of-life care for late disease
2. Definitive

TCC is sensitive to radiotherapy and chemotherapy; SCC is not sensitive

Early disease;

• TCC- transurethral resection of bladder tumour (TURBT), followed by chemotherapy or radiotherapy.
• Follow up quarterly for 1st yr, half-yearly for 2nd yr, and yearly thereafter with cystoscopy.
• There’s a role for BCG.
• SCC- cystectomy followed by neobladder construction or urinary diversion

Late disease;

• Palliative care- chemotherapy, immunotherapy
• Urinary diversion

Metastases– lung, liver, bone