Ranks ninth in worldwide cancer incidence. Egypt, Western Europe, and North America have the highest incidence rates and Asian countries the lowest rates. More than 90% of new cases occur in people ≥55 years of age.
Gross or microscopic hematuria is the primary symptom of bladder cancer. Screening for hematuria appears to markedly improve the prognosis of bladder cancer.
Cystoscopy and urinary cytology are key to making the diagnosis. Low-grade tumors are papillary and easy to visualize, but often have negative cytology. High-grade tumors are often flat or in situ and difficult to visualize, but typically have a positive cytology.
Complete transurethral resection is the treatment of choice for tumors that have not invaded the detrusor muscle, but recurrence is high. Seeding after surgery is reduced by intravesical instillation of chemotherapy.
High-grade disease is potentially lethal and requires aggressive treatment and close follow-up. Treatment of choice for carcinoma in situ and high-grade tumors not invading muscle is immunotherapy using tuberculosis vaccine BCG.
Muscle-invasive tumors are treated with neoadjuvant chemotherapy, cystoprostatectomy, and extended pelvic lymphadenectomy. Neoadjuvant chemotherapy and thorough pelvic node dissection both significantly increase 5-year survival. Precautions should be taken to prevent wound seeding during cystoprostatectomy.
Combination cisplatinum-based chemotherapy such as methotrexate, vinblastine, doxorubicin, and cisplatin produces response in ≥50% of cases. Less-toxic combinations, such as cisplatin with either gemcitabine or taxol, or all 3 together, appear to have similar efficacy and less toxicity.
Low-grade, noninvasive (Ta) papillary urothelial carcinoma. Note adjacent satellite tumor, illustrating the field effect
From the collection of Donald Lamm, MD, FACS