Cancer of the Bladder

Understanding bladder cancer, the cause, symptoms, stages and outcome

1. Cancer of the Bladder www.aboutcancer.com

2. Most Common Cancers in the US 2014 Data Breast 235,030 Prostate 233,000 Lung 224,210 ColoRectal 138,830 Skin 81,220 Lymphoma 79,990 Bladder (#7) 74,690 Kidney 63,920

3. Bladder Cancer in the US 2014 Statistics New Cases: 74,690 or 4.5% of all Cancer Deaths: 15,580 or 2.7% of all Survival at 5 years (2004-2010) is 77.4%

4. Bladder Cancer in the US 2014 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

5. 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.

6. 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 .

7. Diagnosing Bladder Cancer

8. 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)

9. 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%

10. Understanding the Pathology Report Type of cancer ( urothelial or papillary) Invasive or non-invasive Grade (how mutated are the cells) Biopsy (how deep) to determine the stage. This information plus imaging studies will determine the clinical stage Final pathology report after major surgery will determine the pathologic stag e

11. Radiology Imaging to Stage Bladder Cancer

12. bladder bladder IV Contrast Cancer Cancer CT Scan CT Scan with contrast rectum

13. kidney kidney cancer bladder CT Scan with contrast

14. Lumbar spine Pubic bone rectum sacrum bowel cancer bladder dye CT Scan with contrast

15. CT or MRI

16. MRI Bladder Cancer

17. MRI Bladder Cancer

18. CT and PET

19. CT and PET Cancer Normal Bladder

20. PET Scan Cancer Normal Bladder

21. 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

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

23. Layers of the Bladder Wall ureter urothelium l amina propria muscle fat peritoneum Bladder wall

24. Urothelium or Transitional cell layer L amina propria or Connective tissue Muscle layer Fat layer Layers of the Bladder Wall

25. 1. Epithelium 2. Subepithelial Connective Tissue 3. Muscle 4. Perivesical Fat Invades local organs Invades pelvic or abdominal wall

26. Stage 0 (Papillary Carcinoma and Carcinoma in Situ)  Abnormal cells are found in the tissue lining the inside of the bladder

27. Stage I Bladder Cancer  Cancer has spread to the layer of connective tissue next to the inner lining of the bladder.

28. 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)

29. Stage II Bladder Cancer  Cancer has spread to the layers of muscle tissue of the bladder.

30. 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.

31. 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.

32. 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%

33. Observed 5 Year Survival by Stage NCDB 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%

34. 5 Year Survival by Stage NCDB 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

35. Lymph Node Spread in Bladder Cancer

36. 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%

37. 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.

38. 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.