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Bladder Cancer Overview: Bladder cancer is the 4th most common cancer in United States men accounting for 7% of all new male cancer cases. Bladder cancer is less common in women as it is the 11th most common female cancer. The life time risk of bladder cancer in men is one in twenty seven and for women one in eighty five. The most common cause of bladder cancer is cigarette smoking, but only 50% of bladder cancer patients are smokers. The most common histologic type of bladder cancer is transitional cell carcinoma accounting for over 90% of cases. Approximately 2/3 of bladder cancers are superficial and 1/3 are invasive into the muscle of the bladder. Typically superficial bladder cancer can be treated with a transurethral resection (bladder preserving). Often intravesical (therapy instilled into the bladder) BCG or chemotherapy is given after the resection to help prevent recurrences. Since the risk of recurrence is high, patients with superficial bladder cancer need regular cystoscopy for at least 10 years after their initial bladder cancer diagnosis. If patients undergo vigilant follow up progression to invasive bladder cancer and death from bladder is rare. In contrast to superficial bladder cancer, invasive bladder cancer is lethal; 30 – 40% of all patients with invasive bladder cancer eventually die from metastatic bladder cancer. Most patients with invasive bladder cancer require a complete cystectomy (bladder removal) with urinary diversion and chemotherapy. What does the bladder do? The bladder is a hollow organ in the pelvis whose primary function is to store and expel urine. The urine made in the kidneys and transported through the ureters into the bladder, where it is stored until it is expelled through the urethra. The internal urinary sphincter provides passive urinary control, and the external urinary sphincter is responsible for volitional control (ie. it is the external sphincter that you control when you are trying to prevent release of urine. that are both responsible for urinary continence. The wall of the bladder is comprised of four distinct layers; an inner lining comprised of urothelial cells, a submucosal layer comprised of smooth muscle, a muscularis layer comprised of detrusor muscle and adventitial layer comprised of blood vessels and fat.  What are the causes of bladder cancer? The most common cause of bladder cancer is cigarette smoking accounting for approximately 50% of all bladder cancer cases. It is estimated that cigarette smoking increases the life time risk of developing bladder cancer by twofold to threefold as compared to non-smokers. The exact reason why cigarette smoking causes bladder cancer is not know but it is believed to be related to carcinogenic acrylamines that get absorbed into the blood stream during smoking and then gets excreted into the urine which comes in contact with the bladder. Other causes of bladder cancer include occupational exposures in rubber factories and dye manufacturers. Chronic infection or protracted bladder irritation (by bladder stones or an indwelling foley catheter) are other risk factors for bladder cancer. Pelvic radiation can also increase the risk for bladder cancer, but radiation-induced bladder cancers typically do not occur until at least 10 years following the radiation therapy. What are the symptoms of bladder cancer? The most common symptom of bladder cancer is hematuria (blood in the urine). This can either be gross hematuria (blood in the urine that you can see with your eyes) or microscopic hematuria (blood in the urine that can only be seen under the microscope). Hematuria can be caused by non-cancerous conditions such as infection and BPH (prostate enlargement) but should be considered a result of cancer until proven otherwise. Thus, most patients with hematuria should be evaluated with a urine culture, urine cytology, CT scan and a cystoscopy (a lighted telescope passed into the bladder through the urethra). Hematuria from bladder cancer can be intermittent so even a single of episode of hematuria should be evaluated. In other words resolution of hematuria does not mean that bladder cancer does not exist. Urinary frequency and urgency are other symptoms of bladder cancer, but these are more commonly the result of non-cancerous condition such as urinary tract infection, bladder instability and benign prostatic hyperplasia. Causes of Hematuria - Urinary tract infection
- Benign prostate hyperplasia
- Bladder cancer
- Ureteral cancer
- Kidney cancer
- Prostate cancer
- Radiation
- Kidney disease
- Idiopathic (no specific cause)
How is bladder cancer diagnosed? Most bladder cancers are diagnosed by a cystoscopy and transurethral biopsy. A CT scan or MRI may detect a bladder tumor but the diagnosis of bladder cancer must be confirmed with a cystoscopy and biopsy. Often a complete resection can be performed during the initial biopsy. Flexible Cystoscopy Bladder Cancer Staging The most important factors determining the prognosis for patients with bladder cancer are the tumor stage and tumor grade. Tumor stage refers to the depth of penetration of the tumor and the extent of spread. Tumor stage is determined by transurethral biopsy and CT or MRI scans. The tumor grade refers to the microscopic appearance of the bladder cancer and is determined by the pathologic examination of the tumor biopsy specimen.  Bladder Cancer Grades Grade 1 (well differentiated) 
Grade 2 (moderately differentiated) 
Grade 3 (poorly differentiated) 
Bladder Cancer Staging Ta – Non-invasive papillary CIS – Carcinoma in situ T1 – Tumor invades connective tissue under the epithelium (surface layer) T2 – Tumor invades bladder muscle T3 – Tumor invades perivesical fat T4 – Tumor invades contiguous structures such as the prostate, uterus, vagina, abdominal or pelvic wall. Histologic Types of Bladder Cancer - Transitional cell carcinoma – most common
- Squamous cell carcinoma – caused by chronic irritation or infection
- Adenocarcinoma – rare
- Small cell carcinoma – extremely rare
Bladder Cancer Treatment Ta (some T1) - transurethral resection +/- intravesical BCG or mitomycin instillations T2 / T3 (some T1) - radical cystectomy, pelvic lymph node dissection +/- systemic chemotherapy Types of Urinary Diversions - Ileal conduit
- Continent cutaneous (Indiana Pouch)
- Orthotopic neobladder
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The prostate is a male endocrine organ that is normally the size of a golf ball. The primary function of the prostate is in male fertility by secreting enzymes and nutrients that promote sperm motility and enhance fertilization of the female egg. Without a prostate a man is not fertile. The prostate does not secrete male hormones and does not play a role in sexual function. Thus men can maintain normal sexual function even after the prostate has been removed. As men age the prostate frequently grows in size and can often block the flow of urine. The condition of “enlarged prostate” is called benign prostatic hyperplasia or BPH. In other words for most men an “enlarged prostate” is not caused by prostate cancer, but rather a non-cancerous condition. Prostatitis is another common benign condition that affects the prostate. Men affected by prostatitis often complain of pain in the perineal or rectal area as well as urinary frequency.
Renal cell carcinoma (aka Kidney Cancer) is the 7th and 9th most common cancer in United States men and women, respectively. There are an estimated 54,390 new cases of kidney cancer and 13,010 deaths from kidney cancer each year. A man’s lifetime risk to develop kidney cancer is 1 in 59. Kidney cancer typically effects men and women 40 years of age or older, but kidney cancer cases in younger patients have occurred. Although there are several risk factors including smoking, obesity, diabetes and exposure to certain chemicals and medications, most people diagnosed with kidney cancer do not have these risk factors. Kidney cancer is often genetic so relatives of kidney cancer patients have an increased risk of getting kidney cancer. Flank pain and blood in the urine can be signs of kidney cancer, but most patients are diagnosed with kidney cancer before symptoms develop. The most common type of kidney cancer is clear cell renal cell carcinoma. Papillary, chromophobe or collecting duct are less common sub-types. CT scans and/or ultrasounds performed for other reasons are currently the most common methods of diagnosing kidney cancer. The best treatment for kidney cancer is surgical removal of the kidney mass, which today can usually be accomplished with a less invasive surgical approach (laparoscopic or robotic). The cure rate for surgery when the kidney tumor is contained within the kidney is 80 – 90%. A robotic partial nephrectomy can usually be performed for tumors 5 cm or smaller, thereby sparing most of the unaffected kidney tissue. If the cancer has spread beyond the kidney (this occurs about 25 – 30% of the time) cures rates are much lower and patients typically require systemic (whole body) immunologic or biologic therapies in addition to cytoreductive nephrectomy.
