Bladder Tumor

Angelyn Christabella

Bladder Tumor

= Malignant growths within the urinary bladder = ‘Bladder Cancer’

Three main histologic types of bladder tumors

• Urothelial carcinoma (most common)• Squamous cell carcinoma• Adenocarcinoma

Development of urothelial carcinoma is related to age and exposure to environmental

carcinogens, primarily smoking

Are separated pathologically and clinically

• Non-muscle-invasive (noninvasive)– multifocal and frequently recur– some may progress to invasive disease

• Muscle-invasive (invasive)

CAUSE AND RISK

Common causes of urothelial carcinoma of the bladder

• Cigarette smoking -- 4x higher incidence• Industrial exposure -- workers in dye, textile,

tire, rubber, and petroleum industries• Chemical exposure • Cyclophosphamide exposure

Common causes of squamous cell carcinoma of the bladder

• Schistosomiasis: infection with Schistosoma haematobium (seen mainly in the Middle East and Africa)

• Urinary calculi, if present for many years• Indwelling catheters, if used for many years (in

spinal cord injury patients)• Bladder diverticula

Bladder Diverticula

Common causes of adenocarcinoma of the bladder:

• Metastases from other primary malignancies• Bladder exstrophy• Secondary site/local invasion of tumors from

other organs (eg, colon)

Bladder Extrophy

Associated disorders

• Urinary tract infection• Benign prostatic hyperplasia -- may be a comorbid finding

EPIDEMIOLOGY

Incidence and Prevalence

• It is estimated that 69,250 new cases ( 52,020 men; 17,230 women) of bladder ∼ ∼cancer have been diagnosed in the U.S. in 2011

• 70% of new cases arer noninvasive tumors (Ta, T1, or carcinoma in situ [Tis])

• 30% are muscle-invasive tumors (T2-T4)

Demographics• Age:

– Incidence and mortality increase with age– From 2004 to 2008 the median age at diagnosis for bladder cancer was 73 years

• Disease-related mortality:– It is estimated that 14,990 men and women died of bladder cancer in 2011; 7.7 deaths

per 100,000 men and 2.2 deaths per 100,000 women

• Gender:– Male : female = 3 : 1

• Race:– White male to black male ratio of 2 to 1– White female to black female ratio of 1.3 to 1.0– Bladder cancer is rare in Asian and Native American people

Demographics• Genetics:

– Multifactorial involving both genetic and environmental factors– No epidemiologic evidence for a hereditary cause in most cases– Familial clusters have been reported

• Geography:– Industrialized countries

• Socioeconomic status:– An occupational link is well recognized – industial and chemical

exposure– Depending on frequency of exposure there is a latent period of

up to 50 years

SYMPTOMS

• Painless gross hematuria• Pain -- late feature• May also be asymptomatic• Possible (not specific):– Painful urination– Urinary frequency and urgency

• More advanced disease– Weight loss– Abdominal and bone pain– Anemia due to acute or chronic blood loss– An abdominal mass may be palpable if the bladder

is filled with a blood clot or if a large tumor is present

DIAGNOSIS

• Histologic examination of bladder biopsy is necessary for diagnosis

THERAPYdepends on histologic type, tumor grade, and depth of invasion

• Progression to invasive disease– Radical cystectomy is typically performed– Patients who do not wish to undergo cystectomy

may be treated with aggressive transurethral resection of bladder tumor (TURBT) in combination with radiation therapy and/or chemotherapy

• Multiple lesions or recur frequently– Intravesical therapy with Bacillus Calmette-Guérin

(BCG) live or mitomycin C

• Advanced bladder carcinoma (metastase)– MVAC (Methotrexate, Vinblastine,

Adriamycin/Doxorubicin, Cisplatin)

• Patients who report episodes of gross hematuria should be referred to a urologist urgently

• Urgent urologic referral is recommended if there is concern for renal failure resulting from obstructive uropathy

PROGNOSIS

• Depends mainly on tumor histology – Subtype as well as presence of unfavorable

pathological features), stage (depth of invasion), and grade

PRIMARY PREVENTION

Screening

• People who work in high-risk occupations may be eligible for screening

• Urine cytology or bladder washing– The high rate of telomerase activity in bladder

carcinoma

THANK YOU