Epidemiology of Bladder CA
Accts for > 90% of UG tumors 4th most common CA in men, 9th in women Annual New Cases = 68,810 (51,230 in M & 17,580 in F) M:F = 3:1, similar w/in all racial groups Annual Deaths = 14,100 (7,750 in M & 4,150 in F)
Cyclophosphamide, Ifosfamide ( 9 fold incd risk) Pelvic radiation txs Arsenic (eg, in drinking H2O)
Other
Prior h/o bladder CA Low fluid intake (incd exposure to carcinogens via decd bladder emptying) Genetics (eg, Retinoblastoma gene) Bladder birth defects (eg, persistent urachus) incd risk for adenoCAR
Pathology of Bladder CA
Transitional cell CAR (> 95%) Papillary (70%) Grow toward the hollow part of the bladder w/o invading deeper tissues. Often non-invasive. Flat Do not grow toward the hollow part of the bladder. Can be non-invasive or invasive depending on depth of invasion Squamous cell (keratinizing) CAR (1-3%) Generally invasive. AdenoCAR (1-2%) Generally invasive. Small cell CAR (< 1%) Mixed-histology (predominantly transitional cell w/ areas of other elements) are also common.
Dx of Bladder CA
Screening of aSxc pts not recommended Pts w/ hematuria, especially if > 40 yoa
Urinary Cytology Cystoscopy, regardless of cytology results (mainstay of dx) Transurethral resection of all visible tumors to determine histology & depth of invasion Biopsies of erythematous (& possibly normal) areas to assess for CIS
Dx of Bladder CA
Pts w/ (+) cytology but no apparent bladder tumors and/or (-) biopsies
Intravenous peylogram or CT urogram to evaluate for upper urinary tract dz
Imaging
Generally only if (+) cystoscopy U/S, CT, or MRI - Can help determine extent of tumor spread (eg, into perivsesical fat, prostate or vagina, LNs) CT chest / abdomen, MRI, radionuclide imaging of skeleton to assess for distant mets
Orthotopic Neobladder
Low-pressure reservoirs anastomosed to the urethra more natural drainage, as pts can void via the urethra. CIs = Renal insuff, inability to self-catheterize, or an exophytic tumor or CIS in the urethra.
Harrisons Internal Medicine Cecil Textbook of Medicine Cancer: Principles & Practice of Oncology National Cancer Institute website American Cancer Society website
References