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Cyclophosphamide Bladder Cancer — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyCyclophosphamide Bladder CancerSCE Rheumatology

A 60-year-old man with GPA on long-term Cyclophosphamide (cumulative dose 25 g over 18 months) develops painless macroscopic haematuria. Cystoscopy shows a bladder mass. What is the most likely diagnosis?

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Correct answer: C — Cyclophosphamide-associated bladder cancer

Cyclophosphamide-associated bladder cancer (typically transitional cell carcinoma less commonly squamous cell carcinoma) is a well-recognised late complication of Cyclophosphamide therapy caused by the metabolite acrolein. Risk increases with cumulative dose (particularly >36 g) and duration of exposure. MESNA and adequate hydration reduce but do not eliminate bladder toxicity. BSR 2025 AAV guidelines and previous publications recommend long-term urological surveillance in patients with prior significant Cyclophosphamide exposure. Haematuria in this context demands urgent urological assessment.

Reference: BSR 2025 AAV guidelines; Knight A et al 2004 Cyclophosphamide bladder cancer risk