Bladder Malignancy

Question 1

Describe bladder malignancy prevalence/incidence.

Answer 1

Bladder tumors = about:
- 4.5% of ALL malignant tumors
- 2.5% of ALL cancer deaths

Bladder cancer is most common among:
- Men aged 60+

Urothelial (transitional cell) carcinoma:
- most common bladder malignancy
- on inner lining of bladder

Question 2

Describe the clinical presentation of bladder malignancy.

Answer 2

*Hallmark = hematuria (gross or microscopic)

• Often painless
• Possible flank pain if obstruction is present
• Bothersome lower urinary tract s/s:
  - daytime voiding frequency
  - nocturne
  - urgency
  - urge urinary incontinence

Question 3

How is bladder malignancy identified/diagnosed?

Answer 3

Urinalysis:
- positive for hematuria (gross or microscopic)
- negative for infection

Urine cytology:
- diagnosis

Cystoscopy/fluorescence cystoscopy with tissue biopsy:
- confirmation of diagnosis

MRI/CT:
- staging &/or detection of metastasis

Question 4

Describe treatment for the following bladder cancers: superficial tumors, locally-invasive tumors, and muscle-invasive tumors.

Answer 4

Superficial tumors:
- transurethral resection
–OR–
- laser ablation
–PLUS–
- intravesical chemotherapy
–OR–
- immunotherapy

Locally-invasive tumors:
- radical cystectomy with urinary diversion
–PLUS–
- adjuvant chemotherapy

Muscle-invasive tumors:
- radiation therapy
–PLUS–
- palliative or adjuvant treatment