Bladder Cancer In The Muscle Wall

B Searching For The Evidence: Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions

Publication Date Range

Searches will begin in January 1990, a date early enough to capture all relevant published studies of current treatments for bladder cancer.

Library searches will be updated while the draft report is posted for public comment and peer review to capture any new publications. Literature identified during the update search will be assessed by following the same process of dual review as all other studies considered for inclusion in the report. If any pertinent new literature is identified for inclusion in the report, it will be incorporated before the final submission of the report.

Literature Databases

Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Health Technology Assessment, National Health Sciences Economic Evaluation Database, and Database of Abstracts of Reviews of Effects will be searched to capture both published and grey literature. See Appendix A for the primary Ovid MEDLINE search strategy.

Scientific Information Packets

Manufacturers of currently available and FDA approved treatments for MIBC will be invited to provide SIPs.

Hand Searching

Reference lists of included articles will also be reviewed for includable literature. Searches will also be supplemented by suggestions from the TEP.

Contacting Authors

Process for Selecting Studies

Tests That May Be Done

Physical exam: The doctor will check you for signs of bladder cancer and other health problems. This might include a rectal exam, during which a gloved finger is put into your rectum. If you are a woman, a pelvic exam might also be done. During these exams, the doctor can sometimes feel a bladder tumor.

Urine tests: For these tests, you’ll be asked to pee in a cup. Your urine is then tested for cancer cells, blood, or certain proteins .

Cystoscopy: For this exam, a doctor called a urologist looks at the inside of your bladder using a tool called a cystoscope. This is a thin tube with a tiny light and camera on its end. It’s put through the opening of your urethra and moved up into your bladder.

Blue light cystoscopy: Sometimes, special drugs are put into the bladder during the exam. Cancer cells soak up these drugs and then glow when the doctor shines a blue light through the scope. This can help the doctor see cancer cells that might have been missed with the normal light.

Bladder biopsy: This is needed to know for sure if you have bladder cancer. For this test, a cystoscope is used it to take a tiny piece of the bladder . More than one sample may be taken because sometimes cancer starts in more than one part of the bladder. Salt water washings of the inside of your bladder may also be collected to look for cancer cells. Any samples are sent to a lab and tested to see if there are cancer cells in them.

Types Of Bladder Cancer

The type of bladder cancer depends on how the tumors cells look under the microscope. The 3 main types of bladder cancer are:

• Urothelial carcinoma. Urothelial carcinoma accounts for about 90% of all bladder cancers. It also accounts for 10% to 15% of kidney cancers diagnosed in adults. It begins in the urothelial cells that line the urinary tract. Urothelial carcinoma used to be called transitional cell carcinoma or TCC.

• Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time, these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.

• Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.

There are other, less common types of bladder cancer, including micropapillary, plasmacytoid, sarcomatoid carcinoma of the bladder, and small cell bladder cancer, among others. Sarcomas of the bladder often begin in the fat or muscle layers of the bladder. Small cell bladder cancer is a rare type of bladder cancer that is likely to spread to other parts of the body.

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Understanding The Statistics: Cancer Survival

It is important to remember that all cancer survival numbers are based on averages across huge numbers of people. These numbers cannot predict what will happen in your individual case.

Survival rates will not tell you how long you will live after you have been diagnosed with bladder cancer. But, these numbers can give you an idea of how likely your treatment will be successful. Also, survival rates take into account your age at diagnosis but not whether you have other health conditions too.

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The Impact Of Tumor Invasion To Muscularis Mucosaevascular Plexus On Patient Outcome In Pt1 Bladder Urothelial Carcinoma

• Ahmet SahanKartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Urology, Istanbul, Turkey.
• Fatma GerinMarmara University, Department of Pathology, Istanbul, Turkey.
• Asgar GarayevMarmara University, Department of Urology, Istanbul, Turkey.
• Emine BozkurtlarMarmara University, Department of Pathology, Istanbul, Turkey.
• Alkan Çubuk | Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Urology, Istanbul, Turkey.
• Orkunt OzkaptanKartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Urology, Istanbul, Turkey.
• Kasm ErtasYuzuncu Yl University, Department of Urology, Van, Turkey.
• Yloren TandrMarmara University, Department of Urology, Istanbul, Turkey.
• Haydar Kamil CamMarmara University, Department of Urology, Istanbul, Turkey.
• Ilker TnayMarmara University, Department of Urology, Istanbul, Turkey.

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Questions To Ask The Doctor

• What treatment do you think is best for me?
• Whats the goal of this treatment? Do you think it could cure the cancer?
• Will treatment include surgery? If so, who will do the surgery?
• What will the surgery be like?
• How will I pee after surgery?
• Will I have other types of treatment, too?
• Whats the goal of these treatments?
• What side effects could I have from these treatments?
• Is there a clinical trial that might be right for me?
• What about treatments like special vitamins or diets that friends tell me about? How will I know if they are safe?
• What should I do to be ready for treatment?
• Is there anything I can do to help the treatment work better?
• Whats the next step?

Start And Spread Of Bladder Cancer

The wall of the bladder has many several layers. Each layer is made up of different kinds of cells .

Most bladder cancers start in the innermost lining of the bladder, which is called the urothelium or transitional epithelium. As the cancer grows into or through the other layers in the bladder wall, it has a higher stage, becomes more advanced, and can be harder to treat.

Over time, the cancer might grow outside the bladder and into nearby structures. It might spread to nearby lymph nodes, or to other parts of the body.

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Is Bowel Cancer Hereditary

If you develop bowel cancer before the age of 50, there is a chance you have Lynch syndrome. The medical name for Lynch syndrome is hereditary non-polyposis colorectal cancer . It is thought this is a result of several potential inherited gene mutations. Alternatively, if there are a cluster of cases of bowel cancer in a family if could be a condition called familial adenomatous polyposis .

However, hereditary bowel cancers are relatively uncommon. The NHS note that these two inherited conditions are considered rare.

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What Is The Most Common Type Of Bladder Cancer

Urothelial carcinoma, also called transitional cell carcinoma, is the most common type of bladder cancer, accounting for approximately 9 out of every 10 cases.2 This type of cancer starts in the urothelial cells lining the inner surface of the bladder wall. Cancerous urothelial cells form a tumor that can grow into the deeper layers of the bladder wall and spread to nearby lymph nodes and organs. In some instances, cancer cells may break away from the bladder tumor and form new tumors in distant parts of the body. This is called metastatic bladder cancer.

Urothelial carcinoma bladder tumors may be classified as non-muscle invasive or muscle invasive and assigned to a specific T category according to the nature and extent of their growth.

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What Is Cancer Staging

Staging is a way of describing where the cancer is located, if or where it has invaded or spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancers stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and it can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

For bladder cancer, the stage is determined based on examining the sample removed during a transurethral resection of bladder tumor and finding out whether the cancer has spread to other parts of the body.

This page provides detailed information about the system used to find the stage of bladder cancer and the stage groups for bladder cancer, such as stage II or stage IV.

Genetic Mutations Passed Down In Families

Some genetic mutations are inherited, meaning they are passed down through families from parents to children on the DNA in their cells. There are rare inherited genetic mutations that can increase a persons risk of bladder cancer, such as Cowden disease and Lynch syndrome. There are likely to be other genetic mutations linked to bladder cancer in the future as well because people are twice as likely to be diagnosed with bladder cancer if they have a close family member who has it.

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Review Of Key Questions

AHRQ posted the key questions on the Effective Health Care Website for public comment. The EPC refined and finalized the key questions after review of the public comments, and input from Key Informants and the Technical Expert Panel . This input is intended to ensure that the key questions are specific and relevant.

Morphologic Variants Of Urothelial Carcinoma

Some cases of urothelial carcinoma show morphologic patterns that are recognized as variants morphology. Those include nested variant, micropapillary, lymphoepithelioma-like, sarcomatoid, small cell carcinoma, and adenocarcinoma. These are frequently under-recognized in bladder biopsies and could have therapeutic implications with different criteria for surgery and different chemotherapy regimens.

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If You Have Any Concerns About Bladder Cancer Talk To Your Doctor About Cxbladder

Cxbladder is a cutting-edge genomic urine test that quickly and accurately detects or rules out bladder cancer. The test combines clinical risk factor markers with genetic information, measuring five biomarker genes to detect the presence or absence of bladder cancer in hematuria patients and those being monitored for recurrence.

Cxbladder comes as a suite of tests, each optimised for a different point in the patient journey:

• Cxbladder Triage: Incorporates known bladder cancer risk factors to help quickly rule out the disease.
• Cxbladder Detect: Designed to work alongside other tests to improve overall detection accuracy.
• Cxbladder Monitor: A non-invasive surveillance alternative that can reduce the need for frequent cystoscopies.

Cxbladder gives you peace of mind and will help your physician make informed treatment decisions.

Speak to your doctor or urologist to learn more about Cxbladder and which test might be right for you. You can also contact our Customer Service Team directly. Contact us for more information

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Treating Stage I Bladder Cancer

Stage I bladder cancers have grown into the connective tissue layer of the bladder wall , but have not reached the muscle layer.

Transurethral resection with fulguration is usually the first treatment for these cancers. But it’s done to help determine the extent of the cancer rather than to try to cure it. If no other treatment is given, many people will later get a new bladder cancer, which often will be more advanced. This is more likely to happen if the first cancer is high-grade .

Even if the cancer is found to be low grade , a second TURBT is often recommended several weeks later. If the doctor then feels that all of the cancer has been removed, intravesical BCG or intravesical chemo is usually given. If all of the cancer wasn’t removed, options are intravesical BCG or cystectomy .

If the cancer is high grade, if many tumors are present, or if the tumor is very large when it’s first found, radical cystectomy may be recommended.

For people who arent healthy enough for a cystectomy, radiation therapy might be an option, but the chances for cure are not as good.

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Family History Of Bladder Cancer

You may be twice as likely to develop bladder cancer if you have a close relative who has had the disease. A close relative includes a parent, sibling, or child. This possibility may be related to genetic factors that make it harder for the body to remove dangerous chemicals after exposure. In addition, an inherited disease linked to colorectal cancer called Lynch syndrome also increases the risk of bladder cancer.

Treatment Of Bladder Cancer By Stage

Most of the time, treatment of bladder cancer is based on the tumors clinical stage when it’s first diagnosed. This includes how deep it’s thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size of the tumor, how fast the cancer cells are growing , and a persons overall health and preferences, also affect treatment options.

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N Categories For Bladder Cancer

The N category describes spread only to the lymph nodes near the bladder and those along the blood vessel called the common iliac artery. These lymph nodes are called regional lymph nodes. Any other lymph nodes are considered distant lymph nodes. Spread to distant nodes is considered metastasis . Surgery is usually needed to find cancer spread to lymph nodes, since this is seldom seen on imaging tests.

The N categories are described in the table above, except for:

NX: Regional lymph nodes cannot be assessed due to lack of information.

N0: There’s no regional lymph node spread.

The Following Stages Are Used For Bladder Cancer:

Stage 0

In stage 0, abnormalcells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stages 0a and 0is, depending on the type of the tumor:

• Stage 0a is also called noninvasive papillary carcinoma, which may look like long, thin growths growing from the lining of the bladder.
• Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.

Stage I

In stage I, cancer has formed and spread to the layer of connective tissue next to the inner lining of the bladder.

Stage II

In stage II, cancer has spread to the layers of muscle tissue of the bladder.

Stage III

Stage III is divided into stages IIIA and IIIB.

• cancer has spread from the bladder to the layer of fat surrounding the bladder and may have spread to the reproductive organs and cancer has not spread to lymph nodes or
• cancer has spread from the bladder to one lymph node in the pelvis that is not near the common iliac arteries .

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Transurethral Resection Of Bladder Tumour

Transurethral resection of bladder tumour alone in MIBC patients is onlypossible as a therapeutic option if tumour growth is limited to the superficial muscle layerand if re-staging biopsies are negative for residual tumour . In general, approximately 50% of patients will still have toundergo RC for recurrent MIBC with a disease-specific mortality rate of up to 47% withinthis group . A disease-free status at re-staging TURB appearsto be crucial in making the decision not to perform RC . A prospective study by Solsona et al. including 133 patients with radical TURB andre-staging negative biopsies, reported a 15-year follow-up .Thirty per cent of patients had recurrent NMIBC and went on to intravesical therapy, and 30% progressed, of which 27 died of BC. After five, ten, and fifteen years, the resultsshowed CSS rates of 81.9%, 79.5%, and 76.7%, respectively and PFS rates with an intactbladder of 75.5%, 64.9%, and 57.8%, respectively.

In conclusion, TURB alone should only be considered as atherapeutic option for muscle-invasive disease after radical TURB, when the patient is unfitfor cystectomy, or refuses open surgery, or as part of a multimodality bladder-preservingapproach.

7.5.1.1.Guideline for transurethralresection of bladder tumour

HCP = healthcare professional.

Cancerous Tumours Of The Bladder

A cancerous tumour of the bladder can grow into nearby tissue and destroy it. It can also spread to other parts of the body. Cancerous tumours are also called malignant tumours.

Bladder cancer is often divided into 3 groups based on how much it has grown into the bladder wall.

• Non-invasive bladder cancer is only in the inner lining of the bladder .
• Nonmuscle-invasive bladder cancer has only grown into the connective tissue layer .
• Muscle-invasive bladder cancer has grown into the muscles deep within the bladder wall and sometimes into the fat that surrounds the bladder.

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