cancer of the bladder
DESCRIPTION
Understanding bladder cancer, the cause, symptoms, stages and outcomeTRANSCRIPT
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.