- 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?
- 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
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.