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Bladder Cancer

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mbch4kz2's version from 2016-04-16 12:29

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Question Answer
What is the most common type of bladder cancer?Urothelial carcinoma
Name 5 risk factorsSmokiung (2/4x, most important), occupational exposure (rubber and dye industries), exposure to arsenic in drinking water, pelvic radiation from prostate cancer, Type 2 diabetes (however metformin may reduce bladder cancer), chronic inflammation (schistose infection), chronic indwelling catheters, familial
Why are bladder cancers likely to be multifocal and have areas of simultaneous dysplasia?Carcinogens are concentrated and excreted in the urine, thereby exposing them to the cells lining the urinary tract (exposure is prolonged in the bladder). The exposure of the urothelium to carcinogens at roughly the same concentration gives rise to an epithelium from which some cells give rise to carcinogenic tendencies
Name 2 symptomsHaematuria (>80% of patients), urinary frequency
What diagnostic tests would you perform?Urinalysis, urine cytology (positive in 90% of carcinoma in situ, 33% of low grade transitional), CT urogram, cytoscopy, IV urogram, FBC
Name 5 differentialsBPH, haemorrhagic cystitis, prostatitis, UTI, kidney stones, renal cell carcinoma
How would you treat (non-muscle invasive) a low grade cancer?Transurethral resection with immediate post-op intravescial chemo, concurren tTURP
How would you treat (non-muscle invasive) an intermediate risk cancer?Transurethral resection, immediate post-op intravesical chemo, delayed intravescial BCG immunotherapy (or intravescial chemotherapy (Mitomycin), concurrent TURP
How would you treat (non-muscle invasive) a high risk cancer?Transurethral resection, immediate post-op intravesical chmo, delayed iBCG immutherapy, concurrent TURP-- Or radical cystectomy
How would you treat locally invasive organ contained tumour (T2a or T2b)Radical or partial cystectomy, perioperative chemo and post-op chemotherapy (or chemo-radiotherapy)
How would you treat locally invasive, non-organ contained cancer (T3a or T3b)Radical cystecomy with pelvic node dissection, preoperative chemotherapy, post-operative chemo (or chemo-radiotherapy)
How would you treat non-organ contained (T4a or T4b)Chemotherapy, radiotherapy, radical cystoprostatectomy
How would you treat metazoic disease (what drugs?)Systemic chemotherapy (cisplatin, gemcitabine and paclitaxel) 2. Surgical or radiotherapy
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