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Bladder cancer is the ninth most common cancer in the world and is the most common malignant neoplasm in the urinary system. This condition occurs in older individuals, with the majority of patients being older than 65 years of age. Around 90% of bladder cancers are transitional cell carcinoma, and most other cases are squamous cell carcinoma of the bladder, which is associated with chronic bladder irritation. Only 1% of bladder cancers are primary adenocarcinoma, and these cases generally occur in patients with a history of bladder exstrophy or uracheal adenocarcinoma. Chemical carcinogenesis is associated with an increased risk for bladder cancer, with cigarette smoke being one of the most strongly associated factors. Other risk factors include chronic cystitis, Human Papillomavirus infection, upper urinary tract cancer, and bladder augmentation.
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Bladder Cancer Diagnosis
Symptoms of bladder cancer include gross or microscopic hematuria, urinary frequency, urgency dysuria, and ureteral obstruction. Diagnosis of bladder cancer may be delayed due to the number of shared symptoms with other disorders, such as urinary tract infection, cystitis, and prostatitis. This often leads to diagnosis at an advanced stage of the disease. A full urologic evaluation should be done for patients experiencing hematuria. This involves a complete history and physical exam, and in some cases a urine sample, cystoscopy, or intravenous pyelography. After a diagnosis, additional studies, including liver function test, chest x-rays, and blood count should be performed. CT scans for the bladder are helpful in examining the bladder wall thickening and lymph node involvement.
Bladder Cancer Podcasts
Listen to leading physicians discuss bladder cancer on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
In this episode of BackTable Urology, Dr. Aditya Bagrodia speaks with urologist Dr. Anne Schuckman from the University of Southern California about advantages and advice for blue light cystoscopy, a procedure performed to identify bladder tumors during transurethral resection of bladder tumor (TURBT).
We talk with Dr. Siamak Daneshmand, Director of Urologic Oncology at USC Institute Of Urology, about the management of muscle-invasive bladder cancer. Listen to the full episode to learn tips for successful transurethral resections of bladder tumor (TURBT) and cystectomies, using imaging to stage bladder cancers, deciding between a cystectomy vs. trimodality therapy (TMT), and comparisons between neobladder procedures and urinary diversions.
We finish our discussion with Dr. Angie Smith from University of North Carolina at Chapel Hill about peri-operative optimization of radical cystectomies. She discusses pre-operative incentive spirometry, opioid and NSAID regimens, post-operative drains and stents, and the importance of multidisciplinary collaboration.
Bladder Cancer Treatment
The preferred initial therapy for patients with metastatic bladder cancer is a cisplatin based combination chemotherapy. Candidates for this therapy must be evaluated for their ability to tolerate this chemotherapy. Renal function, peripheral neuropathy, hearing abilities, organ function, and comorbidities should be assessed. Patients who are not eligible for cisplatin based combination chemotherapy may be treated with carboplatin based regimens, non-platinum regimens, systemic immunotherapy, or single agent chemotherapy. Patients that have had a partial response to systemic therapies would be good candidates for transurethral resections of metastases or in severe cases, radical cystectomy with urinary diversion. Maintenance therapies, such as avelumab, are used in patients with advanced bladder cancer who did not respond to platinum based chemotherapy. Immunotherapies are used as a second line of treatment, and later line therapies are targeted at tumor alterations and patient preferences.
Bladder Cancer Articles
Read our exclusive BackTable Urology Articles for quick insights on bladder cancer, provided by physicians for physicians.
BCG-unresponsive bladder cancer has distinct criteria for diagnosis and management. Official FDA diagnosis requires the development or recurrence of a high-grade bladder tumor after a patient has received adequate BCG therapy. Treatment duration varies based on whether an induction or maintenance course is indicated.
 Metts, M C, et al. “Bladder Cancer: A Review of Diagnosis and Management.” Journal of the National Medical Association, National Medical Association, June 2000, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640522/
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