Bladder Cancer

Bladder Cancer

 

Bladder cancer is the 4th most common cancer in men and 8th most common cancer in women.

Epidemiology

  • Incidence
    • >65,000 cases yearly
  • Age
    • Approximately 80% are >60 years old
  • Gender
    • Male:female – 3-4:1
  • Ethnic
    • Caucasians twice as affected as Blacks  

Risk Factors 

  • Tobacco use (raises relative risk of bladder cancer to 4)
  • Occupational exposure (rubber, leather, dye and organic solvents)
  • Consumption of large amounts of phenacetin for >10 years
  • History of external beam irradiation (cervical or rectal cancer)
  • Previous history of bladder cancer

Pathophysiology

  • 90-95% are transitional cell
  • Majority are superficial tumors (non-invasive)

Clinical Presentation

  • Gross, painless hematuria
    • 90% of cases
  • Other symptoms include dysuria, frequency and flank pain
  • Bone pain suggests metastatic disease

Diagnosis

  • Urinalysis to confirm hematuria
  • Intravenous pyelography to assess the genitourinary tract
  • Noninvasive urinary antigen tests
    • Not sensitive enough to use in diagnosis or as stand alone post-treatment monitoring
    • Most validated tests
      • Urovysion™ FISH, NMP22®, BTA stat®
    • Other promising tests include:
      • Cytokeratins
      • Telomerase
      • Microsatellite instability
      • Immunocyte
      • Survivin
      • BCLA-4
      • Soluble fas ligand
  • Definitive diagnosis
    • Requires invasive cystoscopic examination

Disease Monitoring

  • Requires long-term monitoring and surveillance
  • Main method for surveillance is cystoscopy and voided urine cytology
    • Recurrence rate approximates 60%
    • 42% risk of tumor progression (stage and grade) over 10 years
      • Higher risk with higher pathologic stage and histologic grade