Bladder cancer: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Pathological Classification=== | ===Pathological Classification=== | ||
Revision as of 22:03, 19 January 2012
| Bladder cancer | |
| ICD-10 | C67, C67.9 |
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| ICD-9 | 188, 188.9 |
| OMIM | 109800 |
| DiseasesDB | 1427 |
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Bladder cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Bladder cancer On the Web |
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American Roentgen Ray Society Images of Bladder cancer |
For patient information click here Steven C. Campbell, M.D., Ph.D.
Overview
Signs and symptoms
Causes
Risk factors
Exposure to environmental carcinogens of various types is responsible for the development of most bladder cancers. Tobacco use (specifically cigarette smoking) is thought to cause 50% of bladder cancers discovered in male patients and 30% of those found in female patients. Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. Occupations at risk are metal industry workers, rubber industry workers, workers in the textile industry and people who work in printing. Some studies also suggest that auto mechanics have an elevated risk of bladder cancer due to their frequent exposure to hydrocarbons and petroleum-based chemicals.[1]
Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes. It has been proposed that hair dyes are a risk factor, and some have shown an odds ratio of 2.1 to 3.3 for risk of developing bladder cancer among women who use permanent hair dyes, while others have shown no correlation between the use of hair dyes and bladder cancer. Certain drugs such as cyclophosphamide and phenacetin are known to predispose to bladder TCC. Chronic bladder irritation (infection, bladder stones, catheters, bilharzia) predisposes to squamous cell carcinoma of the bladder. Approximately 20% of bladder cancers occur in patients without predisposing risk factors. Bladder cancer is not currently believed to be heritable (i.e., does not "run in families" as a consequence of a specific genetic abnormality). [This statement contradicts contents in the section that follows]
Diagnosis
Pathological Classification
90% of bladder cancer are Transitional cell carcinomas (TCC) that arise from the inner lining of the bladder called the urothelium. The other 10% of tumours are squamous cell carcinoma, adenocarcinoma, sarcoma, small cell carcinoma and secondary deposits from cancers elsewhere in the body.
TCCs are often multifocal, with 30-40% of patients having a more than one tumour at diagnosis. The pattern of growth of TCCs can be papillary, sessile (flat) or carcinoma-in-situ (CIS).
The 1973 WHO grading system for TCCs (papilloma, G1, G2 or G3) is most commonly used despite being superseded by the 2004 WHO [2] grading (papillary neoplasm of low malignant potential (PNLMP), low grade and high grade papillary carcinoma.
CIS invariably consists of cytologically high grade tumour cells.
Bladder TCC is staged according to the 1997 TNM system:
- Ta Non-invasive papillary tumour
- T1 Invasive but not as far as the muscular bladder layer
- T2 Invasive into the muscular layer
- T3 Invasive beyond the muscle into the fat outside the bladder
- T4 Invasive into surrounding structures like the prostate, uterus or pelvic wall
Staging
The following stages are used to classify the location, size, and spread of the cancer, according to the TNM (tumor, lymph node, and metastasis) staging system:
- Stage 0: Cancer cells are found only on the inner lining of the bladder.
- Stage I: Cancer cells have proliferated to the layer beyond the inner lining of the urinary bladder but not to the muscles of the urinary bladder.
- Stage II: Cancer cells have proliferated to the muscles in the bladder wall but not to the fatty tissue that surrounds the urinary bladder.
- Stage III: Cancer cells have proliferated to the fatty tissue surrounding the urinary bladder and to the prostate gland, vagina, or uterus, but not to the lymph nodes or other organs.
- Stage IV: Cancer cells have proliferated to the lymph nodes, pelvic or abdominal wall, and/or other organs.
- Recurrent: Cancer has recurred in the urinary bladder or in another nearby organ after having been treated.[3]
Treatment
The treatment of bladder cancer depends on how deep the tumor invades into the bladder wall. Superficial tumors (those not entering the muscle layer) can be "shaved off" using an electrocautery device attached to a cystoscope. Immunotherapy in the form of BCG instillation is also used to treat and prevent the recurrence of superficial tumors.[4] BCG immunotherapy is effective in up to 2/3 of the cases at this stage. Instillations of chemotherapy into the bladder can also be used to treat superficial disease.
Untreated, superficial tumors may gradually begin to infiltrate the muscular wall of the bladder. Tumors that infiltrate the bladder require more radical surgery where part or all of the bladder is removed (a cystectomy) and the urinary stream is diverted. In some cases, skilled surgeons can create a substitute bladder (a neobladder) from a segment of intestinal tissue, but this largely depends upon patient preference, age of patient, renal function, and the site of the disease.
A combination of radiation and chemotherapy can also be used to treat invasive disease. It has not yet been determined how the effectiveness of this form of treatment compares to that of radical ablative surgery.
There is weak observational evidence from one very small study (84) to suggest that the concurrent use of statins is associated with failure of BCG immunotherapy.[5]
Epidemiology
In the United States, bladder cancer is the fourth most common type of cancer in men and the ninth most common cancer in women. More than 47,000 men and 16,000 women are diagnosed with bladder cancer each year. One reason for its higher incidence in men is that the androgen receptor, which is much more active in men than in women, plays a major part in the development of the cancer.[6]
References
- ↑ Occupational Risks of Bladder Cancer in the United States: II. Nonwhite Men - Silverman et al. 81 (19): 1480 - JNCI Journal of the National Cancer Institute
- ↑ Sauter G, Algaba F, Amin MB, Busch C, Cheville J, Gasser T, Grignon D, Hofstaedter F, Lopez-Beltran A, Epstein JI. Noninvasive urothelial neoplasias: WHO classification of noninvasive papillary urothelial tumors. In World Health Organization classification of tumors. Pathology and genetics of tumors of the urinary system and male genital organs. Eble JN, Epstein JI, Sesterhenn I (eds): Lyon, IARCC Press, p. 110, 2004
- ↑ "The Gale Encyclopedia of Cancer: A guide to Cancer and its Treatments, Second Edition. Page no. 137".
- ↑ "BCG immunotherapy of bladder cancer: 20 years on". 353 (9165). 1999: 1689&ndash, 94.
- ↑ "Use of statins and outcome of BCG treatment for bladder cancer". 355 (25). 2006: 2705&ndash, 7.
- ↑ "Scientists Find One Reason Why Bladder Cancer Hits More Men". University of Rochester Medical Center. April 20 2007. Unknown parameter
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External links
Template:Tumors Template:SIB bs:Rak mokraćnog mjehura da:Blærecancer de:Blasenkrebs hr:Rak mokraćnog mjehura no:Urinveiskreft fi:Virtsarakon syöpä sv:Urinvägscancer