Bladder cancer is the second most common cancer of the genitourinary tract. The incidence is higher in whites than in African Americans. The average age at diagnosis is 65 years.
Cigarette smoking accounts for 50% of cases in men and31% in women Occupational exposure Patients who have received cyclophosphamide (Cytoxan). Physical trauma to the urothelium induced by infection,instrumentation, and calculi increases the risk of malignancy. The genetic factors
Transitional cell carcinoma is the second most common genitourinary malignancy in US and third most common cause of death among genitourinary tumors. It is widely accepted that bladder cancer is divided into Non-muscle invasive (Ta,T1) and muscle invasive (T2-4). Carcinoma in situ (CIS) is non-invasive by definition, but is a high-risk lesion.
90-95%transitional-cell carcinoma 3%squamos-cell carcinoma 2%adenocarcinoma <1%small-cell carcinoma
75-85%superficial bladder cancer pTa, pTis, pT1 10-15%muscle-invasive bladder cancer pT2, pT3, pT4 5%metastatic bladder cancer N+, M+
Histological grading is important G1G2G3 Relapse rate42%50%80% Progression rate2%11%45%
70% of bladder tumors are superficial at presentation, limited to the mucosa, submucosa, or lamina propria, and are managed conservatively by endoscopic resection. 60/70% of superficial tumors recur and 20/30% of recurrent tumors will progress to a higher stage or grade. Reuter V..Diagnostic Surgical Pathology. 1994:1767/805. Soloway MS. cancer. Urology 1985;26:18/26.
Of non-muscle invasive bladder tumors,70% present as stage Ta, 20% as T1, and 10% as CIS.
Standard of care=intravesical Therapy transurethral resection Relapse rate:70% adjuvant therapy
The initial management of bladder TCC involves transurethral resection of the tumor. The purpose of the initial resection Remove the cancer, provide accurate clinical staging. (Adequate resection,bimanual examination and imagings)
The use of laser resection or vaporisation of bladder tumors is less documented. The holmium laser is used preference to the neodymium:YAG, due to its low depth of penetration (0.3—0.4mm vs. 4—6 mm). However it has increased levels of tissue destruction with subsequent histological compromise.
Expensive Bleeding is negligible No tissue available Perforationof a hollow, viscous organs
Radical cystectomy implies removal of the anterior pelvic organs: in men, the bladder with its surrounding fat and peritoneal attachments, the prostate, and the seminal vesicles; in women, the bladder and surrounding fat and peritoneal attachments, cervix, uterus, anterior vaginal vault, urethra, and ovaries. This remains the “gold standard” of treatment for patients with muscle invasive bladder cancer
Disease-free survival 5 years after surgery is based on tumor stage: 88% for patients with P0,Pa, or PIS disease; 80% for patients with P1 disease; 81%for patients with P2 disease; 68% for patients with P3a and47% for those with P3b disease; and 44% for patients withP4a disease Recurrences after surgery usually occur within the first 3 years.
External beam irradiation (5000–7000 cGy), delivered infractions over a 5- to 8-week radical cystectomy in well-selected patients with deeply infiltrating bladder cancers. Treatment is generally well tolerated, but approximately 15% of patients may have sig- nificant bowel, bladder, or rectal complications. to
Five-yearsurvival rates for stages T2 and T3 disease range from 18%to 41%. Unfortunately, local recurrence iscommon, occurring in approximately 33–68% of patients. Consequently, radiation as monotherapy is usually offered only to those patients who are poor surgical candidates due to advanced age or significant comorbid problems
Approximately 15% of patients who present with bladder cancer are found to have regional or distant metastases; approximately 30–40% of patients with invasive disease develop distant metastases despite radical cystectomy or definitive radiotherapy. Approximately 13–35% of patients receiving such regimens attain a complete.