Bladder Cancer

– Transitional cell carcinomas account for 90% of all bladder cancers, while squamous cell tumors and adenocarcinomas account for the remaining 10%.

Causes and Incidence

Known carcinogens include tobacco tars and industrial chemical agents found in many rubber, dye, and chemical manufacturing plants, petrochemical plants, printing plants, and paint shops. Chronic irritants (e.g., schistosomiasis, bladder calculi) are predisposing factors. More than 51,600 new cases are diagnosed each year in the United States, and the incidence is three times higher for men.

Disease Process

Transitional cell tumors are characterized by multicentric and papillary growth into the bladder lumen, with potential invasion into the bladder muscle, pelvis, pelvic structures, and surrounding lymph nodes. The lungs, bones, and liver are common sites of metastasis.

Symptoms

Frequency of and burning on urination, hematuria, dysuria, and pyuria are the most common presenting signs and symptoms. Pain in the legs, pelvis, and lower back may develop with invasion and metastasis.

Potential Complications

Fistulas of the ureter or small bowel (or both) and obstruction of the small bowel are possible.

Diagnostic Tests

Filling defects on a cystogram and positive results on urine cytologic tests suggest a neoplasm. The definitive diagnosis is made by cystoscopy and transurethral resectional biopsy. Computed tomography or magnetic resonance imaging with bimanual examination is used forstaging.

Treatments

Surgery
Noninvasive tumors: endoscopy and fulguration; laser therapy for noninvasive tumors Invasive tumors: radical cystectomy with urinary diversion.

Drugs
Chemotherapy: Noninvasive tumors: intravesical instillations with bacille CalmetteGue?rin (BCG), doxorubicin, thiotepa or mitomycin-C for noninvasive tumors Invasive tumors: systemic chemotherapy with multidrug combinations such as cisplatin, methotrexate, doxorubicin, and vinblastine (CMDV), or methotrexate, vinblastine, and cisplatin (MVC).

General
Radiation as a preoperative regimen or as adjunct to chemotherapy; care of and instruction about ileal appliance.