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Blader Cancer

Blader cancer is the second most common urologic cancer. Blader 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

Symptoms and Signs: HematuriaCgross or microscopic, chronic or intermittentCis the presenting symptom in 85B90% of patients with

Table 23B11. TNM staging system for blader 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 blader 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, and

Treatment

A. Intravesical Chemotherapy: Immuno- or chemotherapeutic agents can be delivered directly into the blader 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. Such therapy is

B. 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 in patients with

C. Radiotherapy: External beam radiotherapy delivered in fractions over a

D. Chemotherapy: Fifteen percent of patients with newly diagnosed blader 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 blader in partial or complete responses in 15B35% and