Bladder Cancer Diagnosis

Bladder cancer occurs when there are abnormal (cancerous) cells in the linning of the bladder forming a malignant growth, or tumor. Most commonly, in cells that are in the urothelium. Bladder cancer is the fourth most common type of cancer in men and the eighth most common in women. Bladder cancer is 3 times more common in men than in women. It is common in White American compared to African American (Men twice, Women 1.5 times more)

Types:
1. Transitional cell carcinomas (the most common kind accounting for 90 % of cases) 2. Squamous cell carcinoma (account for 4 % of bladder cancers) 3. Adenocarcinoma (account for only about 2 % of bladder cancers) Rhabdomyosarcoma is a very rare type of bladder cancer that occurs only in children.

Staging:
Staging (AJCC) Stage
0 0a 0is I II

Primary tumor (T)

Tx T0 Ta non-invasive, papillary Tis carcinoma in situ T1 subepithelial connective tissue T2 muscle invasion T2a inner _ detrussor T2b outer _ detrussor T3 perivesical tissue T3a microscopic T3b macroscopic T4 adjacent structures T4a prostate, uterus, vagina T4b pelvic/abdominal wall

Regional nodes (N)

Nx N0 N1 Solitary node < 2 cm N2 Total nodes < 5 cm N3 Total nodes > 5 cm Distant metastases Mx M0 M1 any metastases Grade Gx G1 well G2 moderate G3 poor

III

IV

Clinical Presentation:
Symptoms include:
Abdominal pain Blood in the urine Bone pain or tenderness Fatigue Painful urination Urinary frequency Urinary urgency Urine leakage (incontinence) Weight loss Loss of appetite and weight

Signs include:
Hematuria Irritative voiding Dysuria Frequency Nocturia Urgency Flank pain Abdominal pain Weight loss

Diagnosis:
In addition to a complete medical history and physical examination, the diagnostic procedures for bladder cancer may include the following: 1. Rectal or vaginal examination - can check for the presence of tumors large enough to be felt. 2. Cystoscopy (cystourethroscopy) - examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones. It is gold standard for bladder

cancer screening.
3. Intravenous pyelogram (IVP) - used to detect tumors, abnormalities (like stones,obstructions), and to assess renal blood flow. 4. Laboratory tests - tests may be performed on the urine to check for blood, chemicals, bacteria, and cells. Cancerous cells may be detected using the microscope. 5. Bladder tumor marker studies - tests to determine cellular characteristics and markers or substances released by bladder cancer cells into the urine. 6. Ultrasound (sonography) - used to view internal organs as they function and to assess blood flow through various vessels. 7. Computed tomography scan (CAT scan) - show detailed images of any part of the body with greater bone tissue details 8. Magnetic resonance imaging (MRI) - produce detailed images of soft tissues of the body. 9. Positron emission tomography (PET) - may show areas of cancer that may not be seen on a CT scan or an MRI scan. 10. Bladder biopsy -a procedure in which tissue samples are removed (with a needle or during surgery) from the bladder for examination under a microscope; to determine if cancer or other abnormal cells are present. 11. NMP 22: is a protein that undergoes changes when a bladder cell becomes cancerous. 12. BTA: is protein found in bladder cancer cells but not in normal cells. 13. ImmunoCyt: tests for the presence of three different proteins at the same time. 14. FISH (fluorescent in situ hybridization): This test is able to look directly at the DNA of a cell, searching for malignant cells. There are a number of investigational tests for bladder cancer being evaluated in clinical studies including: urinary bladder cancer test, BLCA-1, BLCA-4, hyaluronic acid, hyaluronidase, Lewis X antigen, microsatellite analysis,QuantiCYt, soluble Fas, survivin, and telomerase.

References:
1. 2. 3. 4. 5. Mark Soloway - Saad Khoury . Bladder Cancer 2nd Edition 2012 Philip W. Kantoff, Anthony L. Zietman, Kenneth Wishnow. Bladder Cancer Cummings KB, Barone JG, Ward WS. Diagnosis and staging of bladder cancer. Donald S Kaufman, William U Shipley, Adam S Feldman. Bladder cancer Pamela Ellsworth, Brett Carswell. 100 Questions & Answers About Bladder Cancer