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Bladder Cancer

Bladder cancer is the second most common urologic cancer. Bladder cancer occurs more commonly in men than women (2.7:1), and the mean age at diagnosis is 65 years. Cigarette smoking and exposure to toxins.

A. Symptoms and Signs: Hematuria-gross or microscopic, chronic or intermittent - is the presenting symptom in 85B90% of patients.

Table 23B11. TNM staging system for bladder cancer.

T: Primary tumor

Tx Cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ (CIS)

Ta Noninvasive papillary carcinoma

T1 Invasion into lamina propria

T2 Invasion into superficial layer of muscularis propria

T3a Invasion into deep layer of muscularis propria

T3b Invasion through serosa into perivesical fat

T4a Invasion into adjacent organs

T4b Invasion into pelvic sidewall

N: Regional lymph nodes

Nx Cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single lymph node , 2 cm

N2 Metastasis in a single lymph node > 2 cm and < 5 cm or multiple

nodes none > 5 cm

N3 Metastasis in lymph node > 5 cm

M: Distant metastasis

Mx Cannot be assessed

M0 No distant metastasis

M1 Distant metastasis present


The natural history of bladder cancer is based on two separate but related processes: tumor recurrence and progression to higher stage disease. Both are related to tumor grade and stage. At initial presentation, approximately 50B80% of bladder cancers will be superficial: Ta, Tis, T1. Lymph node metastases and progression are uncommon in such patients when they are properly treated.


Intravesical Chemotherapy: Immuno- or chemotherapeutic agents can be delivered directly into the bladder by a urethral catheter. They can be used to eradicate existing disease or to reduce the likelihood of recurrence in those who have undergone complete transurethral resection.

Surgical Treatment: Although transurethral resection is the initial form of treatment for all bladder cancers as it is diagnostic, allows for proper staging, and will control superficial cancers, muscle infiltrating cancers will require more aggressive treatment. Partial cystectomy may be indicated.

Radiotherapy: External beam radiotherapy delivered in fractions.

Chemotherapy: Fifteen percent of patients with newly diagnosed bladder cancer will present with metastatic disease, and 40% of those thought to have localized disease at the time of cystectomy or definitive radiotherapy will develop metastases usually within 2 years after the start of treatment. Cisplatin-based combination chemotherapy will result in partial or complete responses in 15B35%.