Urology: Bladder Cancer

Bladder Cancer

Types

  • Urothelial (Transitional Cell) Carcinoma – Most Common (90%)
    • Most Important Risk Factor: Tobacco
  • Squamous Cell Carcinoma
    • Associated with Schistosomiasis
  • Sarcoma
  • Adenocarcinoma

Presentation

  • Painless Hematuria – Most Common Presenting Symptom
    • Microscopic Hematuria Risk of Cancer: 2-5%
    • Gross Hematuria Risk of Cancer: 10-20%
  • Urinary Frequency
  • Urinary Urgency
  • Dysuria

Diagnosis

  • Gold Standard for Diagnosis: Cystoscopy with Biopsy
  • Urine-Based Tumor Markers May Assist
  • All Patients Should Have Additional Imaging (CT/MRI)

Urothelial Carcinoma of the Bladder on Cystoscopy 1

Bladder Cancer CT 2

TNM Staging
  • TNM
  T N M
1 Submucosa or Lamina Propria Single LN+ in True Pelvis Mets
2 2a – Superficial Muscle Layer 2b – Deep Muscle Layer Multiple LN+ in True Pelvis
3 3a – Microscopic Invasion of Perivesical Tissue 3b – Macroscopic Invasion of Perivesical Tissue Common Iliac LN+
4 4a – Invades Prostatic Stroma, Seminal Vesicles, Uterus or Vagina 4b – Invades Pelvic or Abdominal Wall
  • Staging
  T N M
I   T1 N0 M0
II   T2 N0 M0
III A T3-4a N0 M0
T1-4a N1 M0
B T1-4a N2-3 M0
IV A T4b Any N M0
Any T Any N M1a
B Any T Any N M1b

Treatment

  • No Muscle Invasion (T1): Transurethral Resection of Bladder Tumor (TURBT) & Intravesical BCG Chemotherapy
    • BCG – Bacillus Calmette-Guerin Immunotherapy
  • Muscle Invasion (≥ T2): Neoadjuvant Chemotherapy & Radical Cystectomy
    • Radical Cystectomy – Removal of Bladder, Adjacent Organs & Regional LN
    • Requires Urinary Diversion Such as an Ileal Conduit
    • May Consider Additional Adjuvant Chemo-XRT
  • Metastatic Disease: Definitive Chemotherapy

References

  1. Nabbout P, Eldefrawy A, Engles CD, Culkin DJ, Slobodov G. Muscle-invasive bladder cancer in a young adult: a case report and a review of the literature. Cent European J Urol. 2013;66(2):185-7. (License: CC BY-NC-ND-3.0)
  2. Oz II, Altinbas NK, Serifoglu I, Oz EB, Yagci C. The Role of Computerized Tomography in the Assessment of Perivesical Invasion in Bladder Cancer. Pol J Radiol. 2016 Jun 16;81:281-7. (License: CC Not Specified)