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14-September-2008 11:27:25 - Bladder cancer August 2008 Bladder cancer Classification and external resources Histopathology of urothelial carcinoma of the urinary bladder. Transurethral biopsy. HE stain. ICD-10 C67., C67.9 ICD-9 188, 188.9 OMIM 109800 DiseasesDB 1427 eMedicine radio/711 med/2344 med/3022 MeSH D001749 Bladder cancer refers to any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called urothelial cell or transitional cell carcinoma UCC or TCC. Contents 1 Signs and symptoms 2 Causes 2.1 Risk factors 2.2 Genetics 3 Diagnosis 3.1 Pathological Classification 3.2 Staging 4 Treatment 5 Epidemiology 6 References 7 External links Signs and symptoms Bladder cancer characteristically causes blood in the urine; this may be visible to the naked eye frank haematuria or detectable only by microscope microscopic hematuria. Other possible symptoms include pain during urination, frequent urination Pollakiuria or feeling the need to urinate without results. These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including prostate infections and cystitis. Causes Risk factors Exposure to environmental carcinogens of various types is responsible for the development of most bladder cancers. In a 10-year study involving almost 48,000 men, researchers found that men who drank 1.5L of water a day had a significantly reduced incidence of bladder cancer when compared with men who drank less than 240mL around 1 cup per day. The authors proposed that bladder cancer might partly be caused by the bladder directly contacting carcinogens that are excreted in urine. Drinking high quantitites of water dilutes the urine and will reduce contact time that the carcinogens spend in our bladder, potentially reducing our chance of disease. 1 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.citation needed 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.2 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. Genetics Like virtually all cancers, bladder cancer development involves the acquisition of mutations in various oncogenes and tumor supressor genes. Genes which may be altered in bladder cancer include H19, FGFR3, HRAS, RB1 and TP53. Several genes have been identified which play a role in regulating the cycle of cell division, preventing cells from dividing too rapidly or in an uncontrolled way. Alterations in these genes may help explain why some bladder cancers grow and spread more rapidly than others.citation needed A family history of bladder cancer is also a risk factor for the disease. Many cancer experts assert that some people appear to inherit reduced ability to break down certain chemicals, which makes them more sensitive to the cancer-causing effects of tobacco smoke and certain industrial chemicals.citation needed Diagnosis The gold standard of diagnosing bladder cancer is urine cytology and transurethral through the urethra cystoscopy. Urine cytology can be obtained in voided urine or at the time of the cystoscopy bladder washing. Cytology is very specific a positive result is highly indicative of bladder cancer but suffers from low sensitivity a negative result does not exclude the diagnosis of cancer. There are newer urine bound markers for the diagnosis of bladder cancer. These markers are more sensitive but not as specific as urine cytology. They are much more expensive as well. Many patients with a history, signs, and symptoms suspicious for bladder cancer are referred to a urologist or other physician trained in cystoscopy, a procedure in which a flexible tube bearing a camera and various instruments is introduced into the bladder through the urethra. Suspicious lesions may be biopsied and sent for pathologic analysis. 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 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 3 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.4 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.5 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.6 The hemocyanin found in Concholepas concholepas blood has immunotherapeutic effects against bladder and prostate cancer. In a research made in 2006 mice were primed with C. concholepas before implantation of bladder tumor MBT-2 cells. Mice treated with C. concholepas showed a significant antitumor effect as well. The effects included prolonged survival, decreased tumor growth and incidence and lack of toxic effects.7 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.8 References ^ Drinking 2 Litres of water a day - will make you pee, and that's about it! by Wendy Zukerman html in english. Retrieved on 2008-9-10. ^ 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 ion. Page no. 137. ^ BCG immunotherapy of bladder cancer: 20 years on 1999 353 9165: 1689-94. ^ Use of statins and outcome of BCG treatment for bladder cancer 2006 355 25: 2705-7. ^ 1 This Month in Investigative Urology, ScienceDirect ^ Scientists Find One Reason Why Bladder Cancer Hits More Men, University of Rochester Medical Center 2007-04-20. External links Cancer.gov: bladder cancer The Johns Hopkins Bladder Cancer Web Site Bladder Cancer Webcafe Patient created site covering wide range of concerns Bladder Cancer Advocacy Network BCAN Non-profit organization dedicated to improving public awareness and increasing research funding Cancer.Net: Bladder Cancer Bladder Cancer Treatment Options Podcast from the Medical University of South Carolina European School of Urology: Management of Superficial Bladder Cancer An educational course of superficial bladder cancer Medlineplus: Bladder Cancer A massive aggregation of media articles and data collated by patients for patients Forum for patients and carers Retired Cancer Researchers Blog Special issue on bladder cancer 2008. Indian Journal of Urology 24 1. v d e Tumors: urogenital neoplasia: urinary organs C64-C68/D30, 188-189/223 Abdominal Kidney Renal cell carcinoma - Wilms' tumor - Mesoblastic nephroma - Oncocytoma - Angiomyolipoma Ureter Ureteral neoplasm Pelvic Bladder Transitional cell carcinoma - Inverted papilloma Urethra see penile cancer Retroperitoneum Malignant fibrous histiocytoma See also non-congenital, congenital, symptoms/signs Retrieved from http://en..org/wiki/Bladder_cancer Categories: Types of cancer | UrologyHidden categories: Articles needing additional references from August 2008 | All articles with statements | Articles with statements since August 2007 | Articles with statements since April 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية Bosanski Dansk Deutsch Español Français Hrvatski 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий Suomi Svenska ä¸æ–‡ This page was last modified on 9 September 2008, at 21:11
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