Urinary bladder cancer

Where is the bladder when it is empty?

Entirely in the true pelvis

What is the triangular portion of the bladder?

Trigone

Lymphatics of bladder

External iliac

Common iliac

Presacral

Paraortic

Incidence rate is ___ times higher in ________

4, men

Incidence is 2 times higher in what race?

White men

Incidence peaks in what decade of life?

Seventh

Average age

73

Occurs mainly in people over the age of ___

55

Main risk factor

Smoking

Other risk factors

Workplace exposure (industries that include dye, rubber, leather and aluminum making)

Painters

Firefighters

People who live in communities with high levels of arsenic in drinking water

Certain bladder birth defects

Long-term urinary catheters

Lynch Syndrome

Cowden disease (gene mutation)

Most common clinical presentation

Hematuria

Common clinical presentations

Blood in urine

Frequent urination

Painful urination

Urgent urination

Weak urine stream

Nocturia

Indications of advanced disease

Inability to urinate

Lower back pain on one side

Bone pain

Swelling in feet

Tired or weak

Loss of appetite

Most common pathology

Transitional cell carcinoma

Prognosis depends on what factors?

Tumor extent and depth of muscle invasion

Tumor morphology

________ are usually low grade and superficial = favorable prognosis

Papillary tumors

________ tend to be higher grade and generally have a worse prognosis

Infiltrating lesions

Well differentiated

Less aggressive

Poorly differentiated

More aggressive

Routes of spread

Direct extension into or through the wall of the bladder

Distant metastases are the lung, bone, and liver

________ alone or in combination with other treatments, is used in more than 90% of cases

Surgery

Early stage treatment

Surgical removal of the tumor and administer immunotherapy (BCG) or chemo into the bladder (intravesical)

Advanced stage treatment

Removal of the entire bladder (cystectomy), might be followed by immunotherapy, especially in people at higher risk for recurrence

Distant-stage treatment

Chemotherapy, sometimes along with radiation

What method of treatment is typically used when chemotherapy does not work?

Immunotherapy and targeted therapy

Why is timely follow-up important?

High chance of recurrence

Large pelvic field dose

45-50 Gy in 1.8 Gy/fx

Nodal dose with concurrent chemo

45 Gy

Smaller boost field dose

65 Gy, or possibly 70 Gy, if radiation alone is used