Bladder tumours

• Can be;
  • Transitional cell carcinomas
  • Adenocarcinomas
  • Squamous cell carcinomas (rare in the West, may be associated with schistosomiasis)
• Histology is important for prognosis;
  • Grade 1 – differentiated
  • Grade 2 – intermediate
  • Grade 3 – poorly differentiated
• 80% are confined to the bladder mucosa, only 20% penetrate the muscle

Presentation

• Painless haematuria
• Recurrent UTIs
• Voiding irritability

Associations

• Smoking
• Aromatic amines e.g. rubber industry
• Chronic cystitis
• Schistosomiasis (squamous cell)
• Pelvic irradiation

Tests

• Urine – microscopy/cytology
• IVI may show filling defects and ureteric involvement
• Cystoscopy with biopsy
• CT/MRI may show involvement of pelvic nodes

TNM staging of bladder cancer

• Tis – carcinoma in situ
• Ta – tumour confined to the epithelium
• T1 – tumour in the lamina propria
• T2 – superficial muscle involved
• T3 – deep muscle involved
• T4 – invasion beyond bladder

Treatment

• Tis/Ta/T1
  • Diathermy via transurethral cystoscopy
  • Consider intravesical chemotherapy agents (e.g. mitomycin C) for multiple small tumours or high grade tumours
  • Immunotherapy with intravesical BCG may also help with carcinoma in situ and high grade tumours
• T2-3
  • Radical cystectomy is the gold standard
  • Radiotherapy is another option but generally isn’t so successful
  • Post-op chemotherapy is toxic but effective
• T4
  • Usually palliative chemo/radiotherapy
  • Chronic catheterisation and urinary diversions may be required to relieve pain