Bladder Cancer

1

What is the incidence of transitional cell carcinoma (TCC) of the bladder?

Bladder cancer accounts for about 5% of all new cancers in the United States. The American Cancer Society’s estimates for bladder cancer in the United States are 79,030 new cases (60,490 in men and 18,540 in women) and 16,870 deaths for 2017. Recently, the overall rates of new bladder cancers and of cancer deaths have been dropping slightly in women. In men, incidence rates have been decreasing and death rates have been stable.

2

What are the risk factors associated with bladder TCC?

Age (peak incidence in seventh decade), cigarette smoking, occupational exposure to aniline dyes or aromatic amines, phenacetin abuse, and chemotherapy with cyclophosphamide.

3

What are the signs and symptoms of bladder TCC?

Painless hematuria (gross or microscopic) is the most common finding and is present in up to 90% of patients. Frequency, urgency, and dysuria also may be presenting symptoms, especially for carcinoma in situ (CIS).

4

What is the most common histologic type of bladder cancer?

TCC makes up >90% of bladder cancers. Other histologic types include adenocarcinoma, squamous cell carcinoma, and urachal carcinoma.

5

How do you evaluate a patient with hematuria and bladder mass?

Complete workup for hematuria includes (1) urine analysis, culture and bladder washings for cytology; (2) upper tract imaging study to rule out concomitant upper tract disease with computed tomography intravenous pyelogram (IVP) or MRI IVP or IVP; and (3) cystoscopy, which will define further studies (bladder biopsy).

6

How do you manage bladder TCC?

Initial management includes endoscopic transurethral resection and fulguration of bladder lesion. Further treatment is determined by the pathologic stage of the disease.

7