Urothelial Cancer

The whole urinary tract will have been exposed to the same risk factors - although more concentrated in the bladder the whole tract is at risk

Aetiology

• Smoking and increased age are the main risk factors

• Schistosomiasis causes squamous cell carcinoma of the bladder in countries with a high prevalence of the infection (e.g. Central Africa)

• Aromatic amines (e.g. beta-naphthyline) are strongly associated with bladder cancer - were used in dye and rubber industries but have been heavily regulated or banned for many years

Pathophysiology

Types of cancer

• Most common, can be referred to as urothelial cell carcinoma

• Often papillary - finger-like projections

• Can also see carcinoma which arise as flat lesions on a background of CIS - tend to be more high grade

• Can be primary

• Can occur on a background of metaplasia - difficult to distinguish from a colon cancer that has invaded through

• Remnant of the alantois
• From dome of bladder to the umbilicus
• Usually involutes, in some patients remains patent

• Adenocarcinoma can (rarely) arise within it - isolated to bladder dome

• Persistent inflammation gives rise to squamous metaplasia

• Metaplastic epithelium is unstable - increased risk of malignancy

Clinical presentation

• 80% will present with frank haematuria
• All patients presenting with painless haematuria need to be investigated for malignancy

Investigations

• CT-urogram

• Flexible cystoscopy

Management

• Low risk - monitoring

• High risk - intravesical therapy then monitoring

• Muscle invasive disease - surgery (stoma, surgically construct bladder), external beam radiotherapy

• Metastatic disease - cisplatin-based chemotherapy