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Bladder Cancer Diagnosis

Bladder canceroccurs when there are abnormal (cancerous) cells in the linning of the bladderforming 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 WhiteAmerican 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 Primary tumor (T) Regional nodes (N)

00a0isI

TxT0Tanon-invasive, papillaryTiscarcinoma in situT1subepithelial connective tissue

NxN0N1Solitary node < 2 cmN2Total nodes < 5 cmN3Total nodes > 5 cmDistant metastasesMxM0M1any metastases

GradeGxG1wellG2moderateG3poor

II T2muscle invasionT2ainner _ detrussorT2bouter _ detrussor

III T3perivesical tissueT3a

microscopic

T3bmacroscopicT4adjacent structuresT4aprostate, uterus, vagina

IV T4bpelvic/abdominal wall

Clinical Presentation:Symptoms include: Signs include:Abdominal pain HematuriaBlood in the urine Irritative voiding

Bone pain or tenderness DysuriaFatigue FrequencyPainful urination Nocturia

Urinary frequency UrgencyUrinary urgency Flank pain

Urine leakage (incontinence) Abdominal painWeight loss Weight lossLoss of appetite and weight

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Diagnosis:

In addition to a complete medical history and physical examination, the diagnostic procedures forbladder 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 structuralabnormalities 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 orsubstances released by bladder cancer cells into the urine.

6. Ultrasound (sonography) - used to view internal organs as they function and to assess bloodflow through various vessels.

7. Computed tomography scan (CAT scan)- show detailed images of any part of the body withgreater 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 duringsurgery) from the bladder for examination under a microscope; to determine if cancer or otherabnormal 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 Xantigen, microsatellite analysis,QuantiCYt, soluble Fas, survivin, and telomerase.

References:

1. Mark Soloway - Saad Khoury . Bladder Cancer 2nd Edition 20122. Philip W. Kantoff, Anthony L. Zietman, Kenneth Wishnow. Bladder Cancer3. Cummings KB, Barone JG, Ward WS. Diagnosis and staging of bladder cancer.4. Donald S Kaufman, William U Shipley, Adam S Feldman.Bladder cancer5. Pamela Ellsworth, Brett Carswell. 100 Questions & Answers About Bladder Cancer