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Bladder Cancer in Review

By Benjamin T. Herms, M.D., For Physicians, 0 comments
July 22, 2016

 
Dr. Benjamin Herms, OHC Medical Oncologist

Benjamin T. Herms, M.D.
Medical Oncology/Hematology OHC

Bladder cancer – the fourth most common cancer in the United States among men and ninth among women – arises in the lining of the bladder and is highly treatable. With 50,000 new cases diagnosed each year, a quick review is timely:

Risk Factors

  • Smoking is thought to cause about half of all bladder cancers
  • Race – whites are twice was likely as African Americans and Hispanics to have bladder cancer
  • Age – 9 in 10 persons with bladder cancer are over 55
  • Chronic irritation and/or infections
  • Exposure to certain chemicals in the workplace

Screening Tests

Although tumor marker urine tests are available, they are not recommended for screening in patients without signs and symptoms, unless the individual is very high risk (personal history of bladder cancer, birth defects of the bladder and/or exposed to certain chemicals).

Signs and Symptoms

As you know, common signs and symptoms include:

  • Blood in the urine
  • Painful urination
  • Changes in urination habits (frequency, strong unproductive urge, weak stream)
  • Low back pain on one side
  • Loss of appetite and weight loss
  • Weakness/tiredness
  • Swelling in feet
  • Bone pain

Types of Bladder Cancer

  • Urothelial carcinoma (or transitional cell carcinoma) that starts in urothelial cells that line the bladder is the most common type
  • Squamous cell carcinoma –1 to 2 percent incidence
  • Adenocarcinoma – about 1 percent
  • Small cell carcinoma – less than 1 percent incidence
  • Sarcoma and others – very rare

Diagnostic Examinations

Because other conditions, including infections, benign tumors and bladder stones, may present with the same or similar signs and symptoms, further examination is advised:

  • Medical history/physical exam, including DRE and/or pelvic exam
  • Laboratory tests, including urine cytology to detect blood and/or cancer cells, and urine culture to rule out UTI
  • Cystoscopy and/or fluorescence cystoscopy for visualization and/or collection of salt water wash for cytology
  • TURBT (transurethral resection of bladder tumor) to collect tumor and tissue for biopsy

Imaging Tests

Once bladder cancer is diagnosed, additional information is sought through imaging:

  • Intravenous pyelogram (IVP) or Retrograde pyelogram uses contrast medium to examine urinary tract
  • CT urogram to identify size, shape and position of tumors in the urinary tract, enlarged lymph nodes and other abdominal/pelvic organs
  • CT-guided needle biopsy of tumors that have metastasized outside the bladder
  • MRI urogram may be used instead of IVP
  • Ultrasound can determine size of cancer, if it has spread and to look at kidneys
  • Chest x-ray, bone scans and additional biopsies could be helpful to confirm metastasis

Biopsy Results/Prognosis

Invasiveness:

  • Non-invasive (superficial) – only in cells in the lining of the bladder
  • Invasive – when tumor has invaded the wall of the bladder and/or metastasized to nearby organs

Grade:

  • Low-grade (or well-differentiated) cancer looks more like normal tissue, and patients have a good prognosis
  • High-grade (or poorly differentiated or undifferentiated) are more likely to grow into the bladder wall and can be harder to treat
  • Transitional cell carcinoma – more than 90 percent of all bladder cancers arise in transitional cells
  • Squamous cell carcinoma – only 8 percent arise

Categories:

  • Pathologic findings use the American Joint Committee on Cancer’s TNM system and is most often used to further describe bladder cancer, with higher Arabic numerals behind the letters indicating more increasingly serious prognosis:
    • T = tumor
    • N = lymph nodes
    • M = metastasis

Stage:

  • Once TNM categories are determined the information is combined to find bladder cancer stage, defined using Roman numerals I to IV, with 0 as the earliest stage and IV as most advanced.

Treatment Options

  • TUR (transurethral resection) and fulguration – removal of localized tumor and cancer cells
  • Intravesical chemotherapy therapy after TUR (for non-invasive stage 0 or 1) – to eradicate actively growing cancer cells
  • Intravesical immunotherapy after TUR (for non-invasive stage 0 or 1) uses patient’s immune system to prevent recurrence by using BGC (Bacillus Calmette-Guerin) to activate immune cells that, in turn, attack any remaining cancer cells
  • Segmented cystectomy – for low-grade cancer invading just one area of bladder
  • Radical cystectomy – for high-grade, invasive cancer; includes resection of bladder, nearby lymph nodes, part of urethra and nearby organs, if metastasized. In men the prostate, seminal vesicles and part of vas deferens are also resected; in women, the uterus, ovaries, fallopian tubes and part of vagina are also resected, generally followed by reconstructive surgery.
  • Radiotherapy – either pre- or post-surgery, or both
  • Intravenous chemotherapy – alone or in combination with radiotherapy and/or surgery

We hope this review of bladder cancer has been helpful. If you would like to discuss how we might assist in the treatment of your patients – including clinical trials – we welcome your call to 1-800-710-4674.

Source: http://www.cancer.org/cancer/bladdercancer/index

 
 

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