Men are three to four times more likely than women to be diagnosed with bladder cancer. The most common type of bladder cancer is transitional cell carcinoma, comprising 90% of all bladder cancers. Transitional cell carcinomas are staged according to the depth of bladder wall invasion, which also has bearing on treatment options. Superficial transitional cell carcinomas are in the lining of the bladder and have not invaded the deeper bladder muscle wall, whereas muscle invasive cancers have penetrated this layer and are more likely to spread.
Other types of bladder cancer, which are typically less common but more aggressive, include squamous cell carcinomas (2%), which arise due to chronic infection or inflammation, and adenocarcinomas, comprising 1% of bladder cancers and possibly arising from a birth condition known as urachal abnormalities. Finally, small cell carcinomas comprise <1% of bladder cancers, and are typically treated first line with chemotherapy.
Risks & Causes
Smoking is the most significant risk factor for bladder cancer, increasing the risk for bladder cancer approximately three-fold compared to non-smokers. Older age is also associated with a greater risk for bladder cancer, as the average age at diagnosis is 73 years. In addition, there is an association with race, as whites are approximately twice as likely to develop bladder cancer compared to other races.
Certain occupations, such as the dye, rubber, leather, painting and textile industries, are also associated with a greater risk of bladder cancer due to exposure to chemicals at the workplace. Chemotherapy and radiation for other cancers are associated with an increased risk for bladder cancer.
Symptoms & Evaluation
Bladder cancer most commonly presents with blood in the urine, or hematuria. Hematuria is classified as either visible by eye, which is gross hematuria, or under microscopic laboratory examination, microscopic hematuria. Depending on the amount of blood in the urine, the urine may appear yellow, orange, brown, dark or bright red. Bladder cancer may cause burning or discomfort with urination and/or more frequent urination. In addition, bladder cancer may cause obstruction of the urinary system, leading to flank pain and discomfort. Advanced bladder cancer may present with weight loss, fatigue, difficulty or inability to urinate, abdominal and/or lower back pain.
Evaluation for hematuria should include cystoscopy and imaging of the kidneys, ureters and bladder with CAT scan or Magnetic Resonance Imaging (MRI). A positron emission tomography (PET) scan may also be helpful at times to identify whether cancer has spread beyond the bladder. In addition, cystoscopy must be performed to visualize the lining of the bladder and urethra. Suspicious lesions visible on cystoscopy are biopsied to adequately determine the grade and stage of bladder cancer, if present. The depth of cancer invasion into the layers of the bladder wall determines the available treatment options.
Treatment Options
Bladder cancer treatment is dependent on the depth of invasion through the bladder wall. Superficial bladder cancers are treated by resection through the urethra, known as transurethral resection of bladder tumor (TURBT). Under general anesthesia, a scope is inserted into the urethra to navigate the anatomic tube through which the urine exits the body.
For bladder cancer that invades into the muscle of the bladder wall, the gold standard therapy is surgical removal of the entire bladder (radical cystectomy) and dissection of a lymph node to detect whether cancer has spread beyond the bladder. In men, the prostate and seminal vesicles are also removed.
Bladder replacement options are performed with the use of an intestinal segment and are classified as either:
- Incontinent: an incontinent diversion (ileal conduit) requires a bag to be placed over a stoma to capture urine that drains as it is produced
- Continent: a continent diversion stores urine and comes in two types: (1) neobladder or (2) catheterizable pouch that requires insertion of a tube into the diversion to drain urine. Disadvantages of continent diversions include the fact that there may be a greater need to surgically revise the stoma or connections, as these surgical reconstructions are more complex and subject to a higher revision rate, when compared to ileal conduit diversion
Finally, for patients that have other severe medical conditions that make general anesthesia and/or surgery too risky, bladder sparing radiation therapy may be an option.
Clinical Trials
For information on the clinical trials currently open at 日本av色情片 for bladder cancer, .
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