Bladder Cancer😍

Bladder Cancer

Types

  • Transitional Cell Carcinoma (TCC):
    • Most common overall.
    • Etiology (3Cs):
      • Chemicals → Benzidine
      • Cyclophosphamide.
      • Cigarettes.
  • Squamous Cell Carcinoma (SCC):
    • Most common in Africa.
    • Etiology (2S):
      • Smoking.
      • Schistosomiasis.
        • SCC > TCC
  • Adenocarcinoma:
    • Rare.
    • Develops at persistent urachus, Ectopia vesicae
    • Mnemonic: Adeno → A → urAchus

Clinical Features

  • Gross painless hematuria.

Investigations

  • USG KUB:
    • Shows clots/growth inside bladder.
  • Urine cytology: To detect malignant cells.
  • IOC: Cystoscopic biopsy> MRI
  • First draining LN → Obturator LN
  • VIRADS

Cystoscopic biopsy

notion image
  • TURBT
    • followed by Histopathology.
  • MRI: For staging.

Gross

The cheesy mass → no distinct yellow plaques
The cheesy mass → no distinct yellow plaques

Bladder Cancer Management

TURBT (Transurethral Resection of Bladder Tumor)

  • TURBT is a diagnostic and therapeutic procedure used to:
    • Visualize, biopsy, and remove tumors from the bladder wall
    • Performed via the urethra using a resectoscope
    • Gold standard for initial diagnosis and management of bladder cancer

TNM Staging

  • Ta: Non-invasive papillary carcinoma.
  • Tis: Carcinoma in situ.
  • T1: Above muscle layer.
 
notion image
“In ureterosigmoid anastomosis, urinary Cl⁻ and NH₄⁺ are absorbed in colon while HCO₃⁻ and K⁺ are secreted → Hypokalemic, hyperchloremic, normal anion gap metabolic acidosis.”
Mnemonic: A mighty bee is NMP

Non-Muscle Invasive:

Stage
Management
Ta
Observation/Single dose of intravesical mitomycin C (Chemotherapy)
Tis
Intravesical BCG (Immunotherapy) x 6 cycles
T1
Intravesical chemotherapy/BCG
Follow up
Check cystoscopy every 3 months : To look for recurrence

Nuclear matrix protein (NMP) : Urinary marker

Muscle Invasive:

  • T2: Surgery.
  • T3, T4: Chemotherapy → Surgery.
  • If a patient receives chemotherapy and radiation therapy
    • dose of gemcitabine may need to be reduced
    • to avoid increased toxicity.

Radical Cystectomy

Structures Removed:

  • Bladder, iliac LN + obturator LN.
    • In females: Urethra + Total Abdominal Hysterectomy (TAH).

Urinary Diversion:

  • Continent: Neobladder (from ileum).
  • Non-Continent:
    • Ileal conduit (Most common).
NOTE:
  • Ureterosigmoid anastomosis
    • Obsolete due to increased cancer risk, recurrent UTI,
    • Hyperchloremic hypokalemia metabolic acidosis (normal anion gap)
  • CF
    • Predisposed to Hyponatremic hypochloremic metabolic alkalosis.
    • ↑ in sweat Cl⁻ test.
  • Pyloric Stenosis
    • Hypokalemic metabolic alkalosis with paradoxical aciduria.

Partial Cystectomy

  • For small tumors restricted to domes and not involving the ureteric orifice.
  • Check cystoscopy every 3 months for recurrence.
  • Nuclear Matrix Protein (NMP): Urinary marker.