4th Edition

Chapter 13: The Albanian barber

An Albanian barber, who spoke little English, presented with a 2-month history of macroscopic haematuria, dysuria, nocturia and urinary frequency.

  • 1. What are the risk factors for bladder cancer?

    Correct answer:

    • Smoking (relative risk 4)
    • Industrial exposure (dye, paint and rubber industries)
    • Schistosoma haematobium infection (210 million people worldwide)
    • Long-term urinary catheters

He was aged 73 years and had smoked a packet of cigarettes a day since he was 10 years old.

  • 2. What urological symptoms require urgent referral for possible bladder or kidney cancer?

    Correct answer:

    • Macroscopic haematuria with or without a urinary infection
    • Microscopic haematuria in adults aged >=50 years old
    • Recurrent or persistent urinary infection in adults aged >=40 years old
    • An abdominal mass suggestive of bladder or renal cancer

A CT urogram was performed.

  • 3. What does it show?

    Correct answer:
    The CT urogram showed a large filling defect in the bladder. Cystoscopy and transurethral resection of bladder tumour (TURBT) confirmed a moderately differentiated papillary transitional cell carcinoma invading the lamina propria to at least muscularis mucosa (G2 pT1c L0 V0).

  • 4. What do all those letters (G2 pT1c L0 V0) stand for?

    Correct answer:
    G = Grade of tumour (g2 is moderately differentiated)
    P = Pathologically confirmed
    T = Tumour stage of primary
    c = c substage of T1 (means that the tumour extends at least as far as the muscularis mucosa)
    L = Lymphatic vessel invasion (L0 is no invasion)
    V = Venous invasion (V0 is no invasion)

He had a full body CT scan to complete the staging which showed multiple pathological pelvic lymph nodes that were less than 5 cm in diameter (N2 stage) and pulmonary metastases (M1 stage). His overall tumour staging was (T1 N2 M1) and as his ECOG performance status was 1 (restricted in strenuous activity but ambulatory and able to carry out light work, in this case hair cutting) he was treated with palliative combination chemotherapy with gemcitabine and cisplatin.

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