Bladder neoplasm

Histopathology

• 95% originate in transitional epithelium
• Remainder arise from connective tissue (angioma, myoma, fibroma, sarcoma)
• Benign papillary tumours - red sea anemone appearance
• Urothelial cell carcinoma
  • Risk factors
    • Smoking
    • Urothelial carcinogens
      • Textile workers
      • Dye workers
      • Tyre rubber and cable workers
      • Petrol
      • Leather
      • Shoe manufacturers and cleaners
      • Painters
      • Hairdressers
      • Lorry drivers
      • Drill press operators
      • Chemical workers
      • Rodent exterminators
      • Sewage workers
    • Shistosoma haematobilum
  • Staging:
    • Flat, non-invasive carcinoma-in-situ - does carry a poor prognosis unless treated promptly
    • pTa: not invading lamina propria - unlikely to progress, excellent prognosis
    • pT1: invading lamina propria - follow up carefully and treat aggressively as necessary
    • pT2: muscle-invasive - much worse prognosis
  • High-risk factors:
    • High grade
    • pT1 disease
    • Concomitant CIS
    • Multiple primary tumours
    • Recurrent disease at first check cystoscopy, 3 months post-diagnosis

Presentation

• Painless gross haematuria - bladder cancer until proven otherwise
• Constant pain in pelvis usually heralds extravesical spread
• Pain to loin/pyelonephritis - maybe ureteric obstruction and hydronephrosis
• Nerve pain in surrounding areas is a late manifestation

Investigation

• Urine MCS - mostly helpful with high-grade disease and CIS
• FBE/UEC
• CT - filling defect in bladder wall/irregularity/hydronephrosis
• Cystoscopy

Treatment

• Non-muscle invasive tumours
  • Endoscopic surgery
• Muscle-invasive tumours
  • Poor prognosis - 5 year survival around 50%
  • Mostly up front surgery (cystectomy and ileal conduit) followed by CTX