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