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A 68-year-old man, who is a retired painter and in good health, comes to the office at the insistence of his wife. He reports that his urinary stream is smaller and he has occasional dysuria. He has no major medical problems, although he continues to smoke one pack of cigarettes per day. His urinalysis in the office shows microscopic hematuria and an irregular mass is seen in the bladder on CT scan (Figure 72-1). Cystoscopy shows a bladder tumor (Figure 72-2). Complete endoscopic resection is performed and confirms transitional cell carcinoma.

Figure 72-1

CT with contrast reveals a bladder cancer in a 68-year-old man with hematuria. (Courtesy of Michael Freckleton, MD.)

Figure 72-2

Cystoscopic view of the transitional cell carcinoma in the man in Figure 72-1. (Courtesy of Carlos Enrique Bermejo, MD.)

Bladder cancer is a malignant neoplasm of the bladder, almost exclusively urothelial (transitional cell) carcinoma.

  • In 2008, there were approximately 398,329 men and 139,099 women alive in the United States who had a history of cancer of the urinary bladder.1
  • Almost 70,000 new cases (52,020 men and 17,230 women) were diagnosed and approximately 14,990 deaths occurred from bladder cancer in 2011.1 Mean age at diagnosis is 73 years.
  • The age-adjusted incidence rate (based on 2004 to 2008 data) was 21.1 per 100,000 men and women per year with a male-to-female ratio of approximately 4:1. Among men, bladder cancer is more prevalent in whites than in blacks or Hispanics (ratio of 2:1) and more prevalent in whites than in Asian/Pacific Islander or American Indian/Alaska Natives (ratio 2.4:1); for white women, incidence rates are also higher but the differences are not as great.1

  • Ninety percent to 95% are transitional cell cancers and the remainder are nonurothelial neoplasms, including primarily squamous cell, adenocarcinoma, and small cell carcinoma2,3 (Figures 72-1, 72-2, and 72-4). Rare forms include nonepithelial neoplasms (approximately 1%), including benign tumors, such as hemangiomas or lipomas, and malignant tumors, such as angiosarcomas.3
  • Transitional cells line the urinary tract from the renal pelvis to the proximal two-thirds of the urethra. Ninety percent of transitional cell tumors develop in the bladder and the others develop in the renal pelvis, ureters, or urethra.2
  • Most tumors are superficial (75% to 85%).4 At diagnosis, approximately 51% are in situ and 35% are localized (confined to primary site) with an additional 7% of cases having regional spread and 4% having distant metastases at diagnosis (3% unknown).2
  • Multiple tumors are seen in 30% of cases.4
  • Bladder tumor cells are also graded based on their appearance and behavior into well differentiated or low grade (grade 1), moderately well differentiated or moderate grade (grade 2), and poorly ...

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