Bladder Cancer: Difference between revisions
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Other urinary voiding symptoms may present like; urinary frequency, urgency, nocturia, or dysuria. | Other urinary voiding symptoms may present like; urinary frequency, urgency, nocturia, or dysuria. | ||
If the tumor is located close to the bladder neck or urethra, obstructive symptoms like a weakened or interrupted urine flow, the need to strain, or a sensation of not fully emptying the bladder might occur<ref>Hall MC, Chang SS, Dalbagni G, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. ''J Urol.'' 2007;178(6):2314-2330.</ref>. | If the tumor is located close to the bladder neck or urethra, obstructive symptoms like a weakened or interrupted urine flow, the need to strain, or a sensation of not fully emptying the bladder might occur<ref name=":0">Hall MC, Chang SS, Dalbagni G, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. ''J Urol.'' 2007;178(6):2314-2330.</ref>. | ||
== Risk Factors == | == Risk Factors == | ||
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* Medications such as cyclophosphamide | * Medications such as cyclophosphamide | ||
* [[Interstitial Cystitis|Chronic bladder inflammation]], and previous cancer treatments. | * [[Interstitial Cystitis|Chronic bladder inflammation]], and previous cancer treatments. | ||
* Pelvic radiation | * Pelvic radiation<ref name=":1">DeGEORGE KC, Holt HR, Hodges SC. [https://www.aafp.org/pubs/afp/issues/2017/1015/p507.html#risk-factors Bladder cancer: diagnosis and treatment]. American family physician. 2017 Oct 15;96(8):507-14.</ref>. | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
It suggests that bladder cancer screening could be beneficial for specific populations who are at higher risk. For example, people with aristolochic acid nephropathy (a condition associated with an increased risk of developing cancer, including BCa). In this high-risk group, BCa was diagnosed in 50% of the individuals. | It suggests that bladder cancer screening could be beneficial for specific populations who are at higher risk. For example, people with aristolochic acid nephropathy (a condition associated with an increased risk of developing cancer, including BCa). In this high-risk group, BCa was diagnosed in 50% of the individuals<ref name=":2">Dobruch J, Oszczudłowski M. [https://www.mdpi.com/1648-9144/57/8/749 Bladder cancer: current challenges and future directions]. Medicina. 2021 Jul 24;57(8):749.</ref>. | ||
* Cystoscopy | * Cystoscopy<ref>Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ, Messing EM, Miller SD, Peterson AC, Turk TM, Weitzel W. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. The Journal of urology. 2012 Dec;188(6S):2473-81.</ref> | ||
* Imaging of the upper urinary tract imaging | * Imaging of the upper urinary tract imaging | ||
* [[Renal Function Test (RFT)|Renal function testing]] | * [[Renal Function Test (RFT)|Renal function testing]]<ref>Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. American family physician. 2013 Dec 1;88(11):747-54.</ref> | ||
== Management / Interventions == | == Management / Interventions == | ||
=== Medical Treatment === | === Medical Treatment === | ||
Bacillus Calmette-Guerin (BCG) immunotherapy is an important treatment for serious bladder cancer. Doctors have been trying to figure out the best amount and timing for this treatment. A study called EORTC-GU found that using less BCG doesn't reduce side effects and that using the full amount for a longer time works better to stop the cancer from coming back. But, there was a shortage of BCG worldwide, so another study named NIMBUS tried using fewer treatments. | Bacillus Calmette-Guerin (BCG) immunotherapy is an important treatment for serious bladder cancer. Doctors have been trying to figure out the best amount and timing for this treatment. A study called EORTC-GU found that using less BCG doesn't reduce side effects and that using the full amount for a longer time works better to stop the cancer from coming back. But, there was a shortage of BCG worldwide, so another study named NIMBUS tried using fewer treatments<ref name=":2" />. | ||
[[Chemotherapy Side Effects & Syndromes|Chemotherapy]] should as an additional therapy to radical cystectomy that is with extended lymphadenectomy. | [[Chemotherapy Side Effects & Syndromes|Chemotherapy]] should as an additional therapy to radical cystectomy that is with extended lymphadenectomy<ref name=":1" />. | ||
=== Surgical Treatment === | === Surgical Treatment === | ||
Transurethral resection (TURBT) used for the treatment of non-muscle invasive bladder cancer (NMIBCa), that is confined to the bladder's mucosa and estimated to be about 75% of diagnosed bladder tumors. | Transurethral resection (TURBT) used for the treatment of non-muscle invasive bladder cancer (NMIBCa), that is confined to the bladder's mucosa and estimated to be about 75% of diagnosed bladder tumors<ref name=":1" />. | ||
Bladder removal (radical cystectomy) often required for patients with muscle-invasive bladder cancer (MIBCa), and estimated to be about 25-30% of cases. | Bladder removal (radical cystectomy) often required for patients with muscle-invasive bladder cancer (MIBCa), and estimated to be about 25-30% of cases<ref name=":0" /><ref name=":1" />. | ||
== Differential Diagnosis == | == Differential Diagnosis == | ||
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Clinically Relevant Anatomy[edit | edit source]
The bladder wall is composed of four layers, each with its unique structure and function.
- The innermost layer is the urothelium, also known as transitional epithelium, which lines the bladder, kidneys, ureters, and urethra. This layer consists of specialized cells termed urothelial or transitional cells.
- Surrounding the urothelium is the lamina propria, a connective tissue layer that provides support and structure.
- Surrounding the lamina propria is the detrusor muscle or muscularis propria. This layer is made up of smooth muscle fibers arranged in various longitudinal and circular patterns, which are responsible for the bladder's contraction and expansion.
- Serosa is the outermost layer of the bladder wall formed from the peritoneum. This is followed by a layer of fatty connective tissue that separates the bladder from other nearby organs.
Bladder cancer (BCa) is one of the most common cancers worldwide, it's incidence varies globally and is expected to rise in the next decade. In addition, the most common malignancy of the urinary tract. Is almost three times greater in more developed areas
Epidemiology[edit | edit source]
Bladder cancer accounts for as the most common tumors world wide it the sixth most prevalent malignancy and it is about 5% of all new cancer cases in the United States.
Mechanism of Injury / Pathological Process[edit | edit source]
Bladder cancer (BC a) begins when cells in the bladder undergo genetic mutations. That cause cells to grow and divide uncontrollably, overriding the mechanisms that normally regulate their growth and death. The uncontrolled growth of these mutated cells leads to the formation of a tumor, a mass of cancerous cells. In the bladder, these tumors typically start in the urothelial cells lining the inside of the bladder.
The initial step in the development of bladder cancer involves the loss of genetic material on chromosome 9, known as loss of heterozygosity (LOH). This leads to the inactivation of tumor suppressor genes, contributing to the transformation of normal bladder cells into cancerous ones. Specifically, deletions in both the long arm (9q) and short arm (9p) of chromosome 9 are linked to early stages of bladder cancer, such as dysplasia and carcinoma in situ (CIS), which can progress to more invasive cancer. A key region on 9p21, responsible for encoding important tumor-suppressing proteins (p14ARF, p15, and p16), and is often completely deleted in transitional cell carcinoma, a common type of bladder cancer, leading to the loss of these critical tumor suppressor genes. This genetic alteration plays a significant role in the onset and progression of bladder cancer[1].
Clinical Presentation[edit | edit source]
Patient with bladder cancer usually is presented with asymptomatic hematuria that is visible or even by microscobbic that is the most common presentation.
Other urinary voiding symptoms may present like; urinary frequency, urgency, nocturia, or dysuria.
If the tumor is located close to the bladder neck or urethra, obstructive symptoms like a weakened or interrupted urine flow, the need to strain, or a sensation of not fully emptying the bladder might occur[2].
Risk Factors[edit | edit source]
- Geographic location (whites to be about more 2 times than blacks or Hispanics)
- Age (older age)
- Gender (men more than women)
- Cigarette smoking, estimated to be responsible for half of all BCa cases
- Medications such as cyclophosphamide
- Chronic bladder inflammation, and previous cancer treatments.
- Pelvic radiation[3].
Diagnostic Procedures[edit | edit source]
It suggests that bladder cancer screening could be beneficial for specific populations who are at higher risk. For example, people with aristolochic acid nephropathy (a condition associated with an increased risk of developing cancer, including BCa). In this high-risk group, BCa was diagnosed in 50% of the individuals[4].
- Cystoscopy[5]
- Imaging of the upper urinary tract imaging
- Renal function testing[6]
Management / Interventions[edit | edit source]
Medical Treatment[edit | edit source]
Bacillus Calmette-Guerin (BCG) immunotherapy is an important treatment for serious bladder cancer. Doctors have been trying to figure out the best amount and timing for this treatment. A study called EORTC-GU found that using less BCG doesn't reduce side effects and that using the full amount for a longer time works better to stop the cancer from coming back. But, there was a shortage of BCG worldwide, so another study named NIMBUS tried using fewer treatments[4].
Chemotherapy should as an additional therapy to radical cystectomy that is with extended lymphadenectomy[3].
Surgical Treatment[edit | edit source]
Transurethral resection (TURBT) used for the treatment of non-muscle invasive bladder cancer (NMIBCa), that is confined to the bladder's mucosa and estimated to be about 75% of diagnosed bladder tumors[3].
Bladder removal (radical cystectomy) often required for patients with muscle-invasive bladder cancer (MIBCa), and estimated to be about 25-30% of cases[2][3].
Differential Diagnosis[edit | edit source]
add text here relating to the differential diagnosis of this condition
Resources
[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ Shin JH, Lim JS, Jeon BH. Pathophysiology of bladder cancer. InBladder Cancer 2018 Jan 1 (pp. 33-41). Academic Press.
- ↑ 2.0 2.1 Hall MC, Chang SS, Dalbagni G, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol. 2007;178(6):2314-2330.
- ↑ 3.0 3.1 3.2 3.3 DeGEORGE KC, Holt HR, Hodges SC. Bladder cancer: diagnosis and treatment. American family physician. 2017 Oct 15;96(8):507-14.
- ↑ 4.0 4.1 Dobruch J, Oszczudłowski M. Bladder cancer: current challenges and future directions. Medicina. 2021 Jul 24;57(8):749.
- ↑ Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ, Messing EM, Miller SD, Peterson AC, Turk TM, Weitzel W. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. The Journal of urology. 2012 Dec;188(6S):2473-81.
- ↑ Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. American family physician. 2013 Dec 1;88(11):747-54.
