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.
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1. What are the risk factors for bladder cancer?
He was aged 73 years and had smoked a packet of cigarettes a day since he was 10 years old.
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2. What urological symptoms require urgent referral for possible bladder or kidney cancer?
A CT urogram was performed.
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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).
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4. What do all those letters (G2 pT1c L0 V0) stand for?
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.