HJNO Jul/Aug 2022

52 JUL / AUG 2022 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY INTRODUCTION Cancer of the urinary bladder is one of the most common cancers. The most common type of bladder cancer in the United States andWestern Europe is urothelial carcinoma, also known as transitional cell carcinoma (TCC). Other types of bladder cancer are also found occasionally, including squamous carcinoma and adenocarcinoma. In other areas of the world, such as the North African and Mediterranean regions, squamous carcinoma may be seen more often in areas where schistosomiasis (a parasitic infection) is endemic, although urothelial cancer remains the most common bladder cancer there as well. This topic will discuss the risk factors, symptoms, diagnosis, staging, and treatment of urothelial cancer. RISK FACTORS Bladder cancer is more common inmen than women, and the average age for diagnosis is 73 years old. Other risk factors are: 1. Tobacco exposure: More than 50% of bladder cancers are caused by tobacco exposure, including cigarettes, cigars, chewing tobacco, and likely electronic cigarettes (“vaping”). Exposure to sec- ondhand smoke also increases a per- son’s risk. 2. Exposure to chemicals — dyes that in- clude “azo” compounds. 3. Positive family history. SYMPTOMS 1. Blood in the urine (Hematuria). 2. Pain, usually while urinating, in the lower back or pelvis. 3. Voiding issues like inability to pass or difficulty passing urine or urinating too frequently in small amounts. 4. Fatigue, weight loss, lack of appetite. DIAGNOSIS 1. Urine analysis and urine cytology to de- tect bladder cancer cells. 2. CT scans or MRI of the body to detect bladder cancer mass and possible dis- tant metastasis to help us determine the staging of the patient. 3. Cystoscopy: This test is a procedure done by a urologist and is basically a camera inserted in the bladder that will help to identify the bladder cancer and obtain tissue biopsy of the bladder mass; doing that, we will know what kind of bladder cancer cells we are dealing with and also if there is muscle invasion or not. This is important because based on those results the doctor will determine the correct treatment for the patient. STAGING AND GRADING Bladder cancer staging is based upon how far the cancer has penetrated into the tissues of the bladder, whether the cancer involves lymph nodes near the bladder, and whether the cancer has spread beyond the bladder to other organs. Once bladder cancer is confirmed with cystoscopy/biopsy, we can perform further staging studies, including CT scans or MRI of the pelvis. We usually use the TNM (tumor, node, and metastasis) staging for bladder cancer: 1. T0: No tumor is found in the bladder. 2. Ta: The tumor is only found on the inner lining (mucosa) of the bladder. 3. Tis: Carcinoma in situ is a noninvasive but high-grade and typically flat lesion. 4. T1: The tumor has invaded the lamina propria (the tissue under the lining of the bladder) but without involvement of muscle. 5. T2: The tumor has grown into the mus- cle layer of the bladder, either superfi- cially (stage T2a) or deeply (stage T2b). Stage 2 and higher tumors are consid- ered to be muscle-invasive cancers. 6. T3: The tumor has grown through the bladder muscle into the fat layer sur- rounding the bladder. 7. T4: The tumor has spread to surround- ing organs, such as the prostate, bowel, vagina, or uterus. Grading of the tumor is how aggressive the cancer cells are under the microscope. Low-grade cancers can recur but rarely in- vade. High-grade cancers are more likely to recur and become invasive. In noninvasive tumors, the grade may be low or high, while almost all invasive cancers (tumor stage T1 and greater) are high grade. Risk grouping as low, intermediate, or high risk depends on the size, number, and ap- pearance of the tumor if it recurs and how deeply it invades into the bladder. These risk groupings impact the type of treatment used by clinicians. TREATMENT Treatment of bladder cancer depends if the tumor is non-muscle invasive or muscle- invasive. First, we will address the treatment for non-muscle-invasive bladder cancer. Bladder Cancer 2022