cancer of the bladder

Cancer of the Bladder

www.aboutcancer.com

Most Common Cancers in the US2014 Data

Breast 235,030Prostate 233,000Lung 224,210ColoRectal 138,830Skin 81,220Lymphoma 79,990Bladder (#7)

74,690Kidney 63,920

Bladder Cancer in the US2014 Statistics

New Cases: 74,690 or 4.5% of allCancer Deaths: 15,580 or 2.7% of all

Survival at 5 years (2004-2010) is 77.4%

Bladder Cancer in the US2014 Statistics

Men Women

New Cases 56,390 (6.6%) 18,300 (2.3%)

Deaths 11,170 (3.6%) 4,410 (1.6%)

Median Age 72y 74y

Signs and symptoms of bladder cancer

• Blood in the urine (slightly rusty to bright red in color).

• Frequent urination.• Pain during urination.• Lower back pain.

Risk Factors for Bladder Cancer

• Using tobacco, especially smoking cigarettes.• Having a family history of bladder cancer.• Being exposed to certain chemicals in the

workplace.• Past treatment with certain anticancer drugs,

such as cyclophosphamide or ifosfamide, or radiation therapy to the pelvis.

• Drinking well water that has high levels of arsenic.

• Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.

• Using urinary catheters for a long time.

Diagnosing Bladder Cancer

Diagnosing Bladder Cancer

Usually a cystoscopy and biopsy will be done. There are 3 types of cancer but most people will have transitional cell (or urothelial cancer)

This starts in the lining of the bladder and the outlook or prognosis is based on whether the cancer has started to invade the wall of the bladder or the grade (how mutated the cells have become)

Histology

• Urothelial Cancer > 90% (>90% are in bladder, 8% in renal pelvis, 2% in ureter or urethra)

• Squamous Cancer – 3%• Adenocarcinoma – 1.4%• Small Cell – 1%

Understanding the Pathology Report

1.Type of cancer (urothelial or papillary)2. Invasive or non-invasive3.Grade (how mutated are the cells)4.Biopsy (how deep) to determine the stage.

This information plus imaging studies will determine the clinical stage

5.Final pathology report after major surgery will determine the pathologic stage

Radiology Imaging to Stage Bladder Cancer

bladder

bladder

IV Contrast

Cancer

Cancer

CT Scan

CT Scan with contrast

rectum

kidney kidney

cancerbladder

CT Scan with contrast

Lumbar spine

Pubic bone

rectum

sacrum

bowel

cancer

bladder

dye

CT Scan with contrast

CT

or

MRI

MRI Bladder Cancer

MRI Bladder Cancer

CT and PET

CT and PET

Cancer

NormalBladder

PET Scan

Cancer

NormalBladder

Stages of Bladder Cancer

Basically how deep has the cancer invaded into the wall of the bladder and has it spread elsewhere to other organs or lymph nodes

T Stage…how deep into the wall of the bladder the cancer has invaded

Layers of the Bladder Wall

ureter

urothelium

lamina propria

muscle

fat

peritoneum

Bladder wall

Urothelium or Transitional cell layer

Lamina propria or Connective tissue

Muscle layer

Fat layer

Layers of the Bladder Wall

1. Epithelium2. Subepithelial Connective Tissue3. Muscle4. Perivesical Fat

Invades local organs

Invades pelvic or abdominal wall

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

 Abnormal cells are found in the tissue lining the inside of the bladder

Stage I Bladder Cancer

 Cancer has spread to the layer of connective tissue next to the inner lining of the bladder.

Risk of a relapse is related to how deep the cancer invade and how mutated the cancer cells are. Low grade (slow growing) or High grade (more mutated, more fast growing)

Stage II Bladder Cancer

 Cancer has spread to the layers of muscle tissue of the bladder.

Stage III Bladder Cancer

 Cancer has spread from the bladder to the layer of fat surrounding it. It may also have spread to the prostate and/or seminal vesicles in men or the uterus and/or vagina in women.

Stage IV Bladder Cancer

  Cancer has spread from the bladder to (a) the wall of the abdomen or pelvis, (b) one or more lymph nodes, and/or (c) other parts of the body, such as the lung, liver, or bone.

Bladder Cancer in the US

SEER data 2004-2010

Stage Distribution 5 Year Survival

In Situ 51% 96.2% Local 35% 69.2% Regional 7% 33.7% Distant 4% 5.5%

Observed 5 Year Survival by StageNCDB Data 2003-2006

Stage Incidence Survival

Stage 0 51.5% 77.7%Stage I 23.2% 65.3%Stage II 12.4% 37.1%Stage III 5.3% 29.0%Stage IV 7.6% 11.4%

5 Year Survival by StageNCDB Data 1998-2004 Treated with

Cystectomy

Stage Clinical Pathologic

Stage 0 67.2% 70.8%Stage I 62.9% 75.8%Stage II 50.4% 63.7%Stage III 36.9% 41.5%Stage IV 27.2% 24.7%

42% were upstaged at surgery. IJROBP 2014:88:1048

Lymph Node Spread in Bladder Cancer

The odds the cancer has spread to lymph nodes from surgery series

Path Stage Positive Nodes

P0 to P1 2 – 10%P2a 7 – 18%P2b 23 – 27%P3 34 – 51%P4 41 – 65%

All 24%

Survival after Cystectomy by Stage from USC

Pathologic Stage 5 Year 10 Year

T2aN0 77% 57%T2bN0 64% 44%T3N0 49% 29%T4aN0 44% 23%Extravesical N0 47% 27%

All Node Negative 69% 49%All Node Positive 31% 23%

 AJCC cancer staging manual. Philadelphia: Lippincott-Raven, 1997:241–243.

Survival after Cystectomy by Stage from USC

Pathologic Stage 5 Year 10 Year

T2aN0 77% 57%T2bN0 64% 44%T3N0 49% 29%T4aN0 44% 23%Extravesical N0 47% 27%

All Node Negative 69% 49%All Node Positive 31% 23%

 AJCC cancer staging manual. Philadelphia: Lippincott-Raven, 1997:241–243.