Bladder cancer is the 7th most common cancer in the US. In 2014, there were 74,690 new cases and 15,580 deaths. Bladder cancer is more common in men than women. Risk factors include smoking, family history, occupational chemical exposure, and bladder infections. Symptoms include blood in the urine, frequent urination, and pain during urination. Diagnosis involves cystoscopy and biopsy. Staging uses CT, MRI, and PET scans to determine if the cancer has invaded the bladder wall or spread. Higher stage and grade cancers have a worse prognosis. Treatment and survival depend on the stage, with 5-year survival rates ranging from 96% for stage 0 to 5.5% for stage IV cancer

1. Cancer of the
Bladder
www.aboutcancer.com

2. Most Common Cancers in the
US
2014 Data
 Breast 235,030
 Prostate
233,000
 Lung 224,210
 ColoRectal 138,830
 Skin 81,220
 Lymphoma 79,990
 Bladder (#7) 74,690
 Kidney 63,920

3. Bladder Cancer in the US
2014 Statistics
New Cases: 74,690 or 4.5% of all
Cancer Deaths: 15,580 or 2.7% of all
Survival at 5 years (2004-2010) is 77.4%

4. Bladder Cancer in the US
2014 Statistics
Men Women
New Cases 56,390 (6.6%) 18,300 (2.3%)
Deaths 11,170 (3.6%) 4,410 (1.6%)
Median Age 72y 74y

5. Signs and symptoms of
bladder cancer
• Blood in the urine (slightly
rusty to bright red in color).
• Frequent urination.
• Pain during urination.
• Lower back pain.

6. Risk Factors for Bladder
Cancer
• Using tobacco, especially smoking cigarettes.
• Having a family history of bladder cancer.
• Being exposed to certain chemicals in the
workplace.
• Past treatment with certain anticancer drugs,
such as cyclophosphamide or ifosfamide,
or radiation therapy to the pelvis.
• Drinking well water that has high levels
of arsenic.
• Having a history of bladder infections,
including bladder infections caused
by Schistosoma haematobium.
• Using urinary catheters for a long time.

7. Diagnosing Bladder Cancer

8. Diagnosing Bladder Cancer
Usually a cystoscopy and biopsy will be done. There
are 3 types of cancer but most people will have
transitional cell (or urothelial cancer)
This starts in the lining of the bladder and the outlook or
prognosis is based on whether the cancer has started to
invade the wall of the bladder or the grade (how mutated
the cells have become)

9. Histology
• Urothelial Cancer > 90%
(>90% are in bladder, 8% in renal
pelvis, 2% in ureter or urethra)
• Squamous Cancer – 3%
• Adenocarcinoma – 1.4%
• Small Cell – 1%

10. Understanding the Pathology
Report
1.Type of cancer (urothelial or papillary)
2.Invasive or non-invasive
3.Grade (how mutated are the cells)
4.Biopsy (how deep) to determine the stage.
This information plus imaging studies will
determine the clinical stage
5.Final pathology report after major surgery
will determine the pathologic stage

11. Radiology Imaging to Stage
Bladder Cancer

12. bladder
bladder
IV
Contrast
Cancer
Cancer
CT Scan
CT Scan
with
contrast
rectum

13. kidney kidney
cancerbladder
CT Scan with contrast

14. Lumbar
spine
Pubic bone
rectum
sacrum
bowel
cancer
bladder
dye
CT Scan with contrast

15. CT
or
MRI

16. MRI Bladder Cancer

17. MRI Bladder Cancer

18. CT and PET

19. CT and PET
Cancer
Normal
Bladder

20. PET Scan
Cancer
Normal
Bladder

21. Stages of Bladder Cancer
Basically how deep has the cancer invaded into the
wall of the bladder and has it spread elsewhere to
other organs or lymph nodes

22. T Stage…how deep into the wall
of the bladder the cancer has
invaded

23. Layers of the Bladder Wall
ureter
urothelium
lamina
propria
muscle
fat
peritoneum
Bladder wall

24. Urothelium or
Transitional cell
layer
Lamina propria or
Connective tissue
Muscle layer
Fat layer
Layers of the Bladder Wall

25. 1. Epithelium
2. Subepithelial Connective
Tissue
3. Muscle
4. Perivesical Fat
Invades
local
organs
Invades
pelvic or
abdominal
wall

26. Stage 0 (Papillary Carcinoma and Carcinoma in
Situ)
Abnormal cells are found in the tissue lining the inside of the bladder

27. Stage I Bladder Cancer
Cancer has spread to the layer of connective tissue next to the inner lining of the
bladder.

28. Risk of a relapse is related to how deep the
cancer invade and how mutated the cancer
cells are. Low grade (slow growing) or High
grade (more mutated, more fast growing)

29. Stage II Bladder Cancer
Cancer has spread to the layers of muscle tissue of the bladder.

30. Stage III Bladder Cancer
Cancer has spread from the bladder to the layer of fat surrounding it. It may also have
spread to the prostate and/or seminal vesicles in men or the uterus and/or vagina in
women.

31. Stage IV Bladder Cancer
Cancer has spread from the bladder to (a) the wall of the abdomen or pelvis, (b) one
or more lymph nodes, and/or (c) other parts of the body, such as the lung, liver, or
bone.

32. Bladder Cancer in the US
SEER data 2004-2010
Stage Distribution 5 Year Survival
In Situ 51% 96.2%
Local 35% 69.2%
Regional 7% 33.7%
Distant 4% 5.5%

33. Observed 5 Year Survival by
Stage
NCDB Data 2003-2006
Stage Incidence Survival
Stage 0 51.5% 77.7%
Stage I 23.2% 65.3%
Stage II 12.4% 37.1%
Stage III 5.3% 29.0%
Stage IV 7.6% 11.4%

34. 5 Year Survival by Stage
NCDB Data 1998-2004 Treated with
Cystectomy
Stage Clinical Pathologic
Stage 0 67.2% 70.8%
Stage I 62.9% 75.8%
Stage II 50.4% 63.7%
Stage III 36.9% 41.5%
Stage IV 27.2% 24.7%
42% were upstaged at surgery.
IJROBP 2014:88:1048

35. Lymph Node Spread in
Bladder Cancer

36. The odds the cancer has spread
to lymph nodes from surgery
series
Path Stage Positive Nodes
P0 to P1 2 – 10%
P2a 7 – 18%
P2b 23 – 27%
P3 34 – 51%
P4 41 – 65%
All 24%

37. Survival after Cystectomy by
Stage from USC
Pathologic Stage 5 Year 10 Year
T2aN0 77% 57%
T2bN0 64% 44%
T3N0 49% 29%
T4aN0 44% 23%
Extravesical N0 47% 27%
All Node Negative 69% 49%
All Node Positive 31% 23%
AJCC cancer staging manual. Philadelphia: Lippincott-Raven,
1997:241–243.

38. Survival after Cystectomy by
Stage from USC
Pathologic Stage 5 Year 10 Year
T2aN0 77% 57%
T2bN0 64% 44%
T3N0 49% 29%
T4aN0 44% 23%
Extravesical N0 47% 27%
All Node Negative 69% 49%
All Node Positive 31% 23%
AJCC cancer staging manual. Philadelphia: Lippincott-Raven,
1997:241–243.