Bladder Tumours

Question 1

where does urothelium line from

Answer 1

renal pelvis and calyces right down to urethra

Question 2

what are the cells at the luminal surface of urothelium called

Answer 2

umbrella cells - domed surface

Question 3

name 2 special properties of urothelium

Answer 3

• variability in the thickness of the cells represents different states of distension
• apical surface has a thickened membrane to provide a highly impermeable barrier

Question 4

what are 90% of bladder tumours

Answer 4

TCC

Question 5

risk factors for TCC

Answer 5

• Chemical exposure: aniline dyes, aromatic anines (rubber industry), cyclophosphamide
• Analgesics
• Smoking
• Male > female

Question 6

what age are they most common

Answer 6

5th decade of life

Question 7

presentation

Answer 7

• PAINLESS HAEMATURIA
• recurrent UTI
• voiding irritability
• general systemic features

Question 8

which region of the bladder do most TCC occur in

Answer 8

trigone - can cause ureteric obstruction

Question 9

papillary TCC

Answer 9

• superficial, mushroom like shape
• 80% TCC are these, 50% of these are infiltrative malignancies

Question 10

carcinoma in situ - TCC

Answer 10

• very abnormal
• tend to grow quickly
• high grade

Question 11

stage 0a and 0is

Answer 11

Question 12

what stage is stromal and detrusor muscle invasion

Answer 12

Question 13

recurrence of TCC?

Answer 13

• frequent, tumours often progress to a higher grade/stage
• screen with cytstoscopy at least once a year for those with previous cancer

Question 14

investigations

Answer 14

• cystoscopy
• CT urogram provides staging

Question 15

how may the appearance of papillary tumours be described

Answer 15

stippled

Question 16

what proportion of bladder tumours do squamous ones make up

Answer 16

9%

Question 17

how can SCC be caused

Answer 17

• calculi causing chronic irritation to the epithelial lining of the bladder, inflammation and then infection
• leads to metaplasia then SCC

Question 18

risk factors for SCC

Answer 18

• schistosomiasis
• long term indwelling catheter
• renal stone

Question 19

what developmental defect can lead to adenocarcinoma of the bladder

Answer 19

• extroversion - defect where part of the bladder and urethra are exposed, metaplastic changes lead to malignancy

Question 20

embryonal rhabdomyosarcoma

Answer 20

the most common malignant bladder tumour in children, malignant cells resemble developing skeletal muscle of child

Question 21

treatment of superficial cancer

Answer 21

transurethral resection of bladder tumour or local diathermy

Question 22

treatment of cancer that has invaded into the detrusor muscle (T2)

Answer 22

radical cystectomy