Bladder

The age-adjusted incidence rate for bladder cancer between men and women is 20.7 per 100,000 per year, with the incidence rate being much higher in males than in females. Additionally, white males had the highest incidence rate when taking ethnicity into account. 1 Based on rates between 2008 and 2010, 1.12% of men in the U.S. between the ages of 50 and 70 will develop bladder cancer, compared to 0.32% of women. 1 ||
 * **Epidemiolgy:** || Adam
 * **Etiology:** || Megan

The etiology, in layman terms, are the risk factors associated with the development of a disease. But, because the risk exists, does not determine that the disease will develop. In the case of bladder cancer, the primary risk factors is smoking. Other are as follows:


 * Exposure to substances such as soot from coal, or chemicals used to create dyes, or rubber, or those used in textiles
 * Exposure to chemicals used in dry cleaning, or those used to make clothing, rope, paper, or twine
 * Taking a certain Chinese herb, Aristolochia fanghchi, has been indicative of bladder cancer
 * Water with high arsenic levels
 * If someone has a history of bladder infections, kidney stones, or bladder stones, or a heightened use of urinary catheters
 * Previous radiation therapy to the pelvis
 * Having had a kidney transplant
 * Having a hereditary form of colon cancer 2

All of these are indicative of possibly developing or heightening one’s chance of developing bladder cancer. ||
 * **Signs & Symptoms:** || Kevin T

The following is a list of diagnostic workup typically done for carcinoma of the bladder: There are a couple different forms of histology for bladder cancer: The lymphatic drainage of the bladder follows the following pattern:
 * 75-80% experience gross, painless, total (throughout urination) hematuria, although this may also be intermittent
 * 25% - vesicle irritability
 * 20% - no specific symptoms
 * 95% - patients with biopsy-proven carcinoma in situ have positive urine cytology results 3 ||
 * **Diagnostic Procedures:** || Erin
 * Routine:
 * History
 * Physical exam (including rectal examination
 * Laboratory studies:
 * Urinalysis
 * Complete blood cell count
 * Liver function test
 * Radiographic Imaging
 * CT and/or MRI of the pelvis and abdomen
 * Intravenous urogram (should be obtained before cystoscopy)
 * Retrograde pyelogram (when indicated)
 * Chest x-ray
 * Bone scans (for patients with T3 or T4 disease or bone pain)
 * Biopsies of bladder and urethea
 * Transurethral resection (if indicated) 4 ||
 * **Histology:** || Spencer
 * Transitional Cell Carcinoma – Within the US, approximately 92% of bladder cancers consist of this transitional cell carcinoma.1
 * Squamous Cell Carcinoma – 6-7%1
 * Adenocarcinoma – 1-2%1
 * Morphologically, bladder cancers can also be separated into a few different groups. These include papillary, papillary infiltrating, solid infiltrating, nonpapillary, noninfiltrating, or carcinoma in situ. 3 ||
 * **Lymph node drainage:** || Pablo


 * The superolateral portion of the bladder drains into the external iliac lymph nodes
 * The fundus and neck portions of the bladder drain into the internal iliac, sacral and common iliac lypmph nodes. 5

|| Bladder cancer can spread through direct extension into the bladder wall. Approximately 75% to 85% of new bladder cancers are superficial and around 15% to 25% of patients have muscle invasion at the time of diagnosis. Routes of spread may either be through the bloodstream or lymphatic drainage. The most common sites of distant metastatasis are: lung, bone, and liver. 6 || The World Health Organization (WHO) has suggested a grading system in which bladder cancers are only given one of two grades: 7 4 ||
 * **Metastatic spread:** || Becky
 * **Grading:** || Adam
 * Low Grade (Well-differentiated)
 * High Grade (Poorly differentiated) ||
 * **Staging:** || Megan
 * **Radiation side effects:** || Kevin T


 * o Acute – cystitis and diarrhea 3
 * o Complications – bladder (8-10%), rectum (3-4%), small bowel (1-2%)
 * o Radiation cystitis – 10%
 * o Bladder contracture – 1% ||
 * **Prognosis:** || Erin

Stage and grade are the two most important prognostic factors for bladder cancer. The stage of the cancer refers to whether it is superficial or invasive, and whether it has spread to other places in the body. 8 Bladder cancer in the early stages often can be cured. Other factors that affect prognosis are the histology (type of cancer cells and how they look under a microscope) and the patient’s age and general health. || There are a few different methods to treating bladder cancer: Data shows that the TD 5/5 for irradiation of the full contracted bladder is 65 Gray (Gy). If only two thirds of the bladder are irradiated, the TD 5/5 is 80 Gy. The TD 50/5 of the urinary bladder is estimated to be 80 Gy. 10 ||
 * **Treatments:** || Spencer
 * Surgery: Depending on the size of the tumor (tumors usually greater in size) patients will often receive a cystectomy or partial removal of the urinary bladder.
 * Radiation Therapy: The use of radiation therapy is used mostly for patients who are medically inoperable, refuse a cystectomy, or have disease that is too advanced for surgery.1 The 4 field box technique is one of the most widely used for treating bladder cancers, but other fields can also be used as well (AP/PA, rotational, or three field techniques).
 * Chemotherapy: Chemotherapy can be used for bladder cancers at any point in treatment. Chemotherapy is often used before surgery to try and shrink the tumor before extraction. 9  It can also be used during radiation therapy treatments in order to help the radiation work at a faster rate. 9  Depending on how far along the patient is, the size, stage, and grade of the tumor, chemotherapy is used at all different stages of cancer treatment. ||
 * **TD 5/5:** || Pablo

Back to Week 4
 * **References:** || Becky
 * 1) Cancer of the Urinary Bladder. National Cancer Institute Web Site. http://seer.cancer.gov/statfacts/html/urinb.html. Accessed June 21, 2013.
 * 2) National Cancer Institute. Bladder Cancer Treatment. []. Last modified May 10, 2013. Accessed June 21, 2013.
 * 3) Chao C, Perez C, Brady L. Radiation Oncology Management Decisions. 3rd ed. PA: Lippincott Williams and Wilkins; 2011:483-493.
 * 4) Chao KS, Perez CA, Brady LW. Radiation Oncology Management Decisions. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:432-434.
 * 5) Pathology Outlines. Web site. [] Accessed June 19, 2013.
 * 6) Kuban DA, Trad ML. Male reproductive and genitourinary tumors. In: Washington CM, Leaver D, eds. Principles and Practice of Radiation Therapy. 3rd ed. St. Louis, MO: Mosby-Elsevier; 2010: 823-863.
 * 7) Bladder Cancer. Cancer.Net Web Site. http://www.cancer.net/cancer-types/bladder-cancer/staging-and-grading. 2012. Accessed June 21, 2013.
 * 8) National Cancer Institute. Bladder Cancer Treatment. []. Last modified May 10, 2013. Accessed June 18, 2013.
 * 9) Chemotherapy for Bladder Cancer. American Cancer Society Web Site. []. Accessed June 19, 2013.
 * 10) Wikibooks. Website. []. Accessed June 19, 2013. ||