Bladder Tumor

Angelyn Christabella

Bladder Tumor
= Malignant growths within the urinary
bladder
= Bladder Cancer

Three main histologic types of

bladder tumors
Urothelial carcinoma (most common)
Squamous cell carcinoma
Adenocarcinoma

Development of urothelial carcinoma is

related to age and exposure to
environmental carcinogens, primarily
smoking

Are separated pathologically and

clinically
Non-muscle-invasive (noninvasive)
multifocal and frequently recur
some may progress to invasive disease

Muscle-invasive (invasive)

CAUSE AND RISK

Common causes of urothelial carcinoma

of the bladder

Cigarette smoking -- 4x higher

incidence
Industrial exposure -- workers in dye,
textile, tire, rubber, and petroleum
industries
Chemical exposure
Cyclophosphamide exposure

Common causes of squamous cell carcinoma of the

bladder

Schistosomiasis: infection
withSchistosoma haematobium(seen
mainly in the Middle East and Africa)
Urinary calculi, if present for many years
Indwelling catheters, if used for many
years (in spinal cord injury patients)
Bladder diverticula

Bladder
Diverticu
la

Common causes of adenocarcinoma of the bladder:

Metastases from other primary

malignancies
Bladder exstrophy
Secondary site/local invasion of
tumors from other organs (eg, colon)

Bladder Extrophy

Associated disorders
Urinary tract infection
Benign prostatic hyperplasia -- may be a
comorbid finding

EPIDEMIOLOGY

Incidence and Prevalence

It is estimated that 69,250 new cases
(52,020 men; 17,230 women) of
bladder cancer have been diagnosed
in the U.S. in 2011
70% of new cases arer noninvasive
tumors (Ta, T1, or carcinoma in situ
[Tis])
30% are muscle-invasive tumors (T2T4)

Demographics

Age:
Incidence and mortality increase with age
From 2004 to 2008 the median age at diagnosis for bladder cancer was
73 years

Disease-related mortality:
It is estimated that 14,990 men and women died of bladder cancer in
2011; 7.7 deaths per 100,000 men and 2.2 deaths per 100,000 women

Gender:
Male : female = 3 : 1

Race:
White male to black male ratio of 2 to 1
White female to black female ratio of 1.3 to 1.0
Bladder cancer is rare in Asian and Native American people

Demographics
Genetics:
Multifactorial involving both genetic and environmental
factors
No epidemiologic evidence for a hereditary cause in most
cases
Familial clusters have been reported

Geography:
Industrialized countries

Socioeconomic status:
An occupational link is well recognized industial and
chemical exposure
Depending on frequency of exposure there is a latent
period of up to 50 years

SYMPTOMS

Painless gross hematuria

Pain -- late feature
May also be asymptomatic
Possible (not specific):
Painful urination
Urinary frequency and urgency

 More advanced disease

Weight loss
Abdominal and bone pain
Anemia due to acute or chronic blood
loss
An abdominal mass may be palpable if
the bladder is filled with a blood clot or if
a large tumor is present

DIAGNOSIS

 Histologic examination of bladder biopsy is

necessary for diagnosis

depends on histologic type, tumor grade, and depth of

invasion

THERAPY

 Progression to invasive disease

Radical cystectomy is typically
performed
Patients who do not wish to undergo
cystectomy may be treated with
aggressive transurethral resection of
bladder tumor (TURBT) in combination
with radiation therapy and/or
chemotherapy

 Multiple lesions or recur frequently

Intravesical therapy with Bacillus
Calmette-Gurin (BCG) live or
mitomycin C

Advanced bladder carcinoma

(metastase)
MVAC (Methotrexate, Vinblastine,
Adriamycin/Doxorubicin, Cisplatin)

 Patients who report episodes of gross

hematuria should be referred to a
urologist urgently
Urgent urologic referral is
recommended if there is concern for
renal failure resulting from
obstructive uropathy

PROGNOSIS

 Depends mainly on tumor histology

Subtype as well as presence of
unfavorable pathological features),
stage (depth of invasion), and grade

PRIMARY PREVENTION

Screening
People who work in high-risk
occupations may be eligible for
screening
Urine cytology or bladder washing
The high rate of telomerase activity in
bladder carcinoma

THANK YOU