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Bladder Cancer

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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Ep 219 GU ASCO Highlights: Key Takeaways for Clinicians with Dr. Ben Maughan & Dr. Shilpa Gupta

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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.

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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.

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References

[1] 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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