BLADDER CANCER
Posted by admin on August 2nd, 2010The annual incidence of bladder cancer is 20 cases per 100,000 persons.. 40yjof age; the incidence in men is twice that in women. Exposure to dyes and cigarettes are particularly important risk factors. Bladder cancer represents a spectrum of pathologic processes with different tendencies for invasion, spread, and multicentric evolution.
The diagnosis of bladder cancer must be considered in any older patient complaining of gross hematuria not caused by urinary tract infection. A urinalysis revealing > 5 RBCs per high-power field or a positive test for hemoglobin should prompl cystoscopy evaluation. About 10% of older patients with hematuria have bladder cancer. Other common identifiable causes include urethral inflammation, benign prostatic hyperplasia, and bladder stone. Since renal cell or ureteral cancers occasionally cause hematuria that is missed by cystoscopy alone, renal ultrasonography. CT scanning, or IV urography is reasonable in Ihe ojder patient whose hematuria is inadequately explained by cystoscopic findings. However, IV urogram and retrograde pyelogram are the best tests for finding transitional cell carcinoma; the retrograde study helps avoid the complications of IV dye loads. The insensitivity and nonspecificity of urine cytologic examination make il inadequate as the sole test for bladder, ureteral, or renal cancer.
In general, the depth of tumor penetration and histologic grade correspond best with metastatic potential. More than 70% of bladder cancers are discovered as superficial tumors. However, unpredictability of spread and recurrence makes treatment of even superficial tumors difficult. Usually, solitary superficial papillary tumors have (he lowest recurrence rate; multiple superficial tumors, the highest. Although removal of the bladder would seem to be the simplest way to eliminate the risk for metastatic spread, cystectomy is fraught with significant morbid risks lor local disease, infection, dehydration, and acidosis. Kndo-scopic excision, partial cystectomy, intravesical chemotherapy or BCG therapy, and repeated cysloscopic surveillance remain the most common therapies for disease limited to the bladder. Treatment for disease outside the bladder is experimental.
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