Case 1
A 78-year-old female presents with a week history of painless haematuria. She’s a smoker and used to work in the textiles industry. She underwent a flexible cystoscopy.
- What does this image show?
- What are the two-week wait National Institute for Health & Care Excellence (NICE) referral criteria for bladder cancer?
- How would you manage this patient?
- The histology showed a G1pTa lesion under 3cm in size. What follow-up would you arrange for this patient?
- What would be your next steps if the histology had shown G3pT1 disease?
Case 2
A 67-year-old male underwent imaging as part of a haematuria work-up. He is otherwise fit and well and is an ex-smoker.
Figure 1.
Figure 2.
- What does the scan in Figure 1 show?
- What are the surgical and non-surgical treatment options available to this patient if the histology was in keeping with muscle invasive disease, providing there are no distant metastases?
- What surgical risks would you consent the patient for if he decided to undergo surgery?
- How should this patient be followed up following surgery?
- The patient had the test shown in Figure 2 in clinic as part of their postoperative follow-up. What does it show?
- Considering the image above, what are the management options available?
Bladder cancer: answers
Case 1
1. A <3cm bladder tumour with a papillary appearance.
2. The NICE guidelines recommend referral to urology for individuals aged 45 and over and have:
-
Unexplained visible haematuria without urinary tract infection (UTI), or
-
Visible haematuria that persists or recurs after successful treatment of UTI, or
-
Aged 60 and over and have unexplained non visible haematuria and either dysuria or a raised white cell count on a blood test,
-
Non-urgent referral in subjects aged 60 and over with recurrent or persistent unexplained UTI.
3. This patient should have a transurethral resection of bladder tumour (TURBT) with a single dose of intravesical Mitomycin C immediately after resection. If muscle invasive disease is suspected then CT or MRI staging should be undertaken.
4. This patient has low-risk non-muscle invasive bladder cancer (NMIBC) and should be offered cystoscopic follow-up at 3 and 12 months following diagnosis. If the patient has not developed a recurrence within 12 months then they can be discharged back to primary care.
5. The management here differs as the patient has high risk NMIBC. This patient should undergo a re-resection TURBT. The indications for re-resection are the following:
-
Incomplete initial TURBT or concerns about completeness.
-
No muscle in the specimen after initial resection; the exception is primary carcinoma in situ (CIS) tumours
-
All pT1 tumours.