Bladder cancer, BC

Notes
  • It is the 9th most common cancer globally.
  • The bladder is continuously exposed to hazardous chemicals that have been filtered by the kidneys. This exposure tends to be uniform over the surface of the bladder - a phenomenon that is known as Field cancerization effect. Thus, it is uncommon to find tumor in only one part of bladder.
  • Prevalence of various types of BC is as follows: transitional cell cancer (92%), squamous cancer(5%), adenocarcinoma (2%) and small cell cancer (1%).
  • Risk cancer for BC include: tobacco (3-5 times in smokers), age (more common in people who are above 50 yrs), aromatic amines, schistosomiasis (especially in Africa), infections of bladder, drugs and urinary stones.
  • Statistics: incidence of BC in 2012 - 430,000; ratio of males to females affected by BC- 4 to 1
  1. Staging of BC

 

STAGE

STAGE GROUP-

ING

COMMENTS

0a

Ta

N0

M0

♦Ta-Noninvasive papillary

♦N0- No lymph node metastasis

♦M0-No distant metastasis

0iS

Tis

N0

M0

♦Tis- Tumor in situ

♦N0- No lymph node metastasis

♦M0-No distant metastasis

I

T1

N0

M0

♦T1-Tumor invades subepithelial connective tissue

♦N0- No lymph node metastasis

♦M0-No distant metastasis

II

 

 

 

 

 

T2a

N0

M0

♦T2a-Tumor invades superficial muscle (inner half)

♦N0- No lymph node metastasis

♦M0-No distant metastasis

T2b

N0

M0

♦T2b-Tumor invades deep muscle (outer half)

♦N0- No lymph node metastasis

♦M0-No distant metastasis

III

T3a

N0

M0

♦T3a-Tumor invades perivesical tissue microscopically

♦N0- No lymph node metastasis

♦M0-No distant metastasis

T3b

N0

M0

♦T3b-Tumor invades perivesical tissue macroscopically (extravesical mass)

♦N0- No lymph node metastasis

♦M0-No distant metastasis

T4a

N0

M0

♦T4a-Tumor invades prostate, uterus, or vagina

♦N0- No lymph node metastasis

♦M0-No distant metastasis

IV

T4b

N0

M0

♦T4b-Tumor invades pelvic or abdominal wall

♦N0- No lymph node metastasis

♦M0-No distant metastasis

any T

N1-N3

M0

♦ any T- Any type of tumor of bladder.

♦N1- Metastasis to single node in true pelvis

♦N2- Metastasis to ≥ 2 nodes in true pelvis.

♦N3- Metastasis to ≥ 1 common iliac node

♦M0-No distant metastasis

any T

any N

M1

♦any T

♦any N

♦M1 - Distant metastasis

Symptoms
  • Hematuria
  • Increased frequency of passing urine
  • Burning sensation while passing urine
  • Dysuria
  • Urine containing WBC or pus (pyuria)
  • Anemia
  • Pelvic pain (mainly at advanced stage)
Diagnosis
  • Cystoscopy and biopsy
  • Urine cytology
Differential
  • Cystitis in Females
  • Hemorrhagic Cystitis
  • Nephrolithiasis
  • Renal Cell Carcinoma
  • Renal Transitional Cell Carcinoma
  • Ureteral Trauma
  • UTI in Males
Prevention
  • Avoid tobacco
  • Avoid exposure to aromatic amines
  • Prevention and prompt treatment of schistosomiasis, other infections of bladder and urinary stones.
Management
  • For superficial cancers;

Transurethral resection (TUR BT)

or

Fulguration (laser or electrocautery) and;

Intravesical chemotherapy (at the interval of 1 - 4 wks for 1-2 yrs);

­_Chemotherapeutic drug instillation such as Mitomycin C

_Immunotherapeutic drug instillation such as BCG (more effective than chemotherapeutic drug instillation).

  • Cystectomy (for invasive cancers)

It can be radical (most common) or partial (suitable for less than 5% of patients).

  • Chemotherapy and radiotherapy in case of metastasis
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