1. Bladder Cancer Mark Browning, M.D. ‘77 2.21.16 IUSME

2. Bladder Cancer Pathology Urothelial Cancer…urothelial cells lining the bladder…previously called Transitional Cell Cancer…90% of Bladder Tumors Squamous Cell Cancer 4%...secondary to irritation. i.e., Schistosoma haematobium Adenocarcinoma

3. Describing Bladder Cancer Non-Invasive – Does not extend thru the lamina propria Non-Muscle Invasive – Grown into the lamina propria only Muscle Invasive – Grows into the bladder’s wall muscle

5. Urothelial Carcinoma – 95%

6. Bladder Cancer Incidence/Deaths 77,000 – 58,000 men – 18,000 women 16,000 Deaths per year

7. Bladder Cancer 5 Year Survival 95% for superficial invasion 70% for muscle invasion but no spread 35% if spread to Lymph nodes & surrounding tissue 5% if metastatic TNM Staging & Grading System

8. Diagnosis Urinalysis & Cytology Cystoscopy Transurethral Resection of Bladder Tumor – Sample of Bladder Muscle adjacent to tumor CT, MRI & PET

9. Bladder Cancer Treatment Transurethral Resection of Bladder Tumor Cystectomy Urinary Diversion Intravesical Therapy…BCG Immune RX Systemic Chemotherapy Radiation Therapy

10. Bladder Cancer: Epidemiology Largely preventable – Most cases related to environmental carcinogens Tobacco is a risk factor (causes 1/3-1/2 of all cases) Schistosoma Haematobium

11. Bladder Cancer: Clinical Presentation Painless, macroscopic hematuria (80%) Urinary frequency, dysuria Pelvic pain Systemic symptoms such as bone pain from mets, weight loss Frequent recurrences with superficial bladder cancer Determine whether it is “muscle invasive”

12. Bladder Cancer Fast Facts Most common histology is high grade urothelial cancer Smoking is a major risk factor Commonly presents with gross hematuria