Bladder Cancer: Clinical Aspects and Management

  • Roger B. Watson
  • Howard J. Korman
  • Mark S. Soloway


Nearly 52,000 new cases of bladder cancer and 10,000 deaths were reported in the United States in 1994.1 Although the incidence of bladder cancer has been steadily climbing, the 5-year survival, including all disease stages, has been improving. Bladder cancer is heterogeneous, ranging from superficial papillary lesions (Fig. 7.1) with little malignant potential to invasive tumors (Fig. 7.2) that have metastasized at diagnosis. (See color insert for figures.)


Bladder Cancer Radical Cystectomy Transitional Cell Carcinoma Urinary Diversion Ileal Conduit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Boring CC, Squires TS, Tong T. Cancer statistics, 1994. CA Cancer J Clin 1994; 44CrossRefGoogle Scholar
  2. 2.
    Sorahan T, Lancashire RJ, Sole G. Urothelial cancer and cigarette smoking: findings from a regional case controlled study. Br J Urol 1994; 74: 753–756PubMedCrossRefGoogle Scholar
  3. 3.
    National Cancer Institute: Bladder Cancer Research Report. Washington, DC, US Department of Health and Human Services, National Institutes of Health, 1987:2Google Scholar
  4. 4.
    Wallace DMA. Occupation urothelial cancer. Br J Urol 1988; 61: 175–182PubMedCrossRefGoogle Scholar
  5. 5.
    Lamm DL, Griffith G, Pettit LL, et al. Current perspectives on diagnosis and treatment of superficial bladder cancer. Urology 1992; 39: 301–307PubMedCrossRefGoogle Scholar
  6. 6.
    Vena JE, Freudenheim J, Graham SD, et al. Coffee, cigarette smoking and bladder cancer in western New York. Ann Epidemiol 1993; 3: 586–591PubMedCrossRefGoogle Scholar
  7. 7.
    Morrison SA, Buring JE. Artificial sweeteners in cancer of the lower urinary tract. N Engl J Med 1980; 302: 537–541PubMedCrossRefGoogle Scholar
  8. 8.
    Vena JE, Freudenheim J, Graham SD, et al. Drinking water, fluid intake, and bladder cancer in western New York. Arch Environ Health 1993; 48: 191–198PubMedCrossRefGoogle Scholar
  9. 9.
    El-Bolkainey MN, Mokhtar NM, Ghoneim MA, et al. The impact of schistosomiasis on the pathology of bladder carcinoma. Cancer 1981; 48: 2643–2648CrossRefGoogle Scholar
  10. 10.
    Bennett JK, Wheatley JK, Walton KN. 10 Year experience with adenocarcinoma of the bladder. J Urol 1984; 131: 262–263PubMedGoogle Scholar
  11. 11.
    Mostofi FK, Sobin LH, Toriini H. Histological typing of urinary bladder tumors. In:International Histological Classification of Tumors No. 10. Geneva, World Health Organization, 1973Google Scholar
  12. 12.
    Heney NM, Ahmed S, Flanagan MJ, et al. Superficial bladder cancer: progression and recurrence. J Urol 1983; 130: 1083–1086PubMedGoogle Scholar
  13. 13.
    Jewett HJ, Strong GH. Infiltrating carcinoma of the bladder: relation of depth of invasion of the bladder wall to incidence of local extension and metastasis. J Urol 1946; 55: 366–372PubMedGoogle Scholar
  14. 14.
    Marshall VF. The relation of preoperative estimate to the pathological demonstration of extent of vesical neoplasms. J Urol 1952; 68: 714–723PubMedGoogle Scholar
  15. 15.
    Hermanek P, Sabin LH (eds). UICC—International Union Against Cancer: TNM Classification of Malignant Tumors, 4th ed. Heidelberg, Springer, 1987: 35Google Scholar
  16. 16.
    Beahrs OH, Henson DE.The Manual for Staging of Cancer. Philadelphia, Lippincott-Raven, 1993Google Scholar
  17. 17.
    Heney NM, Nocks BN, Daley JJ, et al. Ta and Tl bladder cancer: location, recurrence, and progression. Br J Urol 1982; 54: 152–157PubMedCrossRefGoogle Scholar
  18. 18.
    Anderstrom C, Johansson S, Nilsson S. The significance of lamina propria invasion on the prognosis of patients with bladder tumors. J Urol 1980; 124: 23–26PubMedGoogle Scholar
  19. 19.
    Hardeman S, Soloway M. Transitional cell carcinoma of the prostate: diagnosis, staging and management. World J Urol 1988; 6: 170–175CrossRefGoogle Scholar
  20. 20.
    Montie JE, Wood DP Jr, Pontes JE, et al. Adenocarcinoma of the prostate in cystoprostatectomy specimens removed for bladder cancer. Cancer 1989; 63: 381–385PubMedCrossRefGoogle Scholar
  21. 21.
    Soloway MS, Lopez AE, Patel J, et al. Results of radical cystectomy for transitional cell carcinoma of the bladder and the effect of chemotherapy. Cancer 1994; 73: 1926–1931PubMedCrossRefGoogle Scholar
  22. 22.
    Ro JY, Staerkel GA, Ayala AG. Cytologic and histologie features of superficial bladder cancer. Urol Clin North Am 1992; 19: 435–453PubMedGoogle Scholar
  23. 23.
    Soloway MS. Flexible cystourethroscopy: alternative to rigid instruments for evaluation of the lower urinary tract. Urology 1985; 25: 472–474PubMedCrossRefGoogle Scholar
  24. 24.
    Matzkin H, Moinuddin S, Soloway MS. Value of urine cytology versus bladder washing in bladder cancer. Urology 1992; 39: 201–203PubMedCrossRefGoogle Scholar
  25. 25.
    Oldbring J, Grifberg I, Mikulski P, et al. Carcinoma of the renal pelvis and ureter following bladder carcinoma: frequency, risk factors and clinicopathological findings. J Urol 1989; 141: 1311–1313PubMedGoogle Scholar
  26. 26.
    Soloway MS, Murphy W, Rao MK, et al. Serial multiple site biopsies in patients with bladder cancer. J Urol 1978; 120: 57–59PubMedGoogle Scholar
  27. 27.
    Lamm DL, Lamm LM. Benefits of intravesical chemotherapy for superficial disease. Contemp Urol 1989; June/ July: 3–11Google Scholar
  28. 28.
    Cant JD, Murphy WM, Soloway MS. Prognostic significance of urine cytology on initial follow up after intravesical mitomycin C for superficial bladder cancer. Cancer 1986; 57: 2119–2122PubMedCrossRefGoogle Scholar
  29. 29.
    Haaf EO, Dresner SM, Ratliff TL, et al. Two courses of intravesical bacillus Calmette-Guérin for transitional cell carcinoma of the bladder. J Urol 1986; 136: 820–824Google Scholar
  30. 30.
    Eure GR, Cundiff MR, Shellhammer PF. Bacillus Calmette-Guérin therapy for high risk stage Tl superficial bladder cancer. J Urol 1992; 152: 376–379Google Scholar
  31. 31.
    Soloway MS, Perito PE: Superficial bladder cancer: diagnosis, surveillance and treatment. J Cell Biochem Suppl 1992; 161: 120–127CrossRefGoogle Scholar
  32. 32.
    Herr HW, Schwalb DM, Zhang Z-F, et al. Intravesical bacillus Calmette-Guérin therapy prevents tumor progression and death from superficial bladder cancer: ten-year follow-up of a prospective randomized trial. J Clin Oncol 1995; 13: 1404–1408PubMedGoogle Scholar
  33. 33.
    Lamm DL. BCG in carcinoma-in-situ and superficial bladder tumors. EORTC Genitourinary Group. J Clin Oncol 1988; 5: 497Google Scholar
  34. 34.
    Herr HW, Wartinger DD, Fair WR, et al. Bacillus Calmette-Guérin therapy for superficial bladder cancer: a ten year follow-up. J Urol 1992; 147: 1020–1023PubMedGoogle Scholar
  35. 35.
    Hudson M. When intravesical measures fail: indications for cystectomy in superficial disease. Urol Clin North Am 1992; 19: 601–609PubMedGoogle Scholar
  36. 36.
    Vieweg J, Whitmore WF, Herr HW, et al. The role of pelvic lymphadenectomy and radical cystectomy for lymph node positive bladder cancer: the Memorial Sloan-Kettering Cancer Center experience. Cancer 1994; 73: 3020–3028PubMedCrossRefGoogle Scholar
  37. 37.
    Skinner DG. The value of regional lymph node dissection in genitourinary cancer. Semin Surg Oncol 1989; 5: 235–239PubMedCrossRefGoogle Scholar
  38. 38.
    Matzkin H, Soloway MS, Hardeman S. Transitional cell carcinoma of the prostate. J Urol 1991; 146: 1207–1212PubMedGoogle Scholar
  39. 39.
    Hardeman S, Soloway MS. Urethral recurrence following radical cystectomy. J Urol 1990; 144: 666–669PubMedGoogle Scholar
  40. 40.
    Schellhammer P, Bean M, Whitmore W. Prostatic involvement by transitional cell carcinoma: pathogenesis, patterns, and prognosis.J Urol 1977; 118: 399–403PubMedGoogle Scholar
  41. 41.
    Bricker M. Bladder substitution after pelvic evisceration. Surg Clin North Am 1950; 30: 1511–1521PubMedGoogle Scholar
  42. 42.
    Montie JE. High-stage bladder cancer: bladder preservation or reconstruction? Cleve Clin J Med 1990; 57: 280–284PubMedGoogle Scholar
  43. 43.
    Sternberg CN, Yagoda A, Scher HI, et al. M-VAC (metho-trexate, vinblastine, doxorubicin and cisplatin) for advanced transitional cell carcinoma of the urothelium. J Urol 1988; 139: 461–469PubMedGoogle Scholar
  44. 44.
    Soloway MS, Einstein A, Corder MP, et al. A comparison of cisplatin and the combination of cisplatin and cyclophos-phamide in advanced urothelial cancer: a national bladder cancer collaborative group study. Cancer 1983; 52: 767–772PubMedCrossRefGoogle Scholar
  45. 45.
    Soloway MS, Ishikawa S, Taylor T, et al. M-VAC or MCV for the treatment of advanced transitional cell carcinoma: metastatic, induction, and adjuvant. J Surg Oncol 1989; 1: 40–45CrossRefGoogle Scholar
  46. 46.
    Skinner DG, Daniels JR, Russell CA, et al. The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial. J Urol 1991; 145: 459–467PubMedGoogle Scholar
  47. 47.
    Logothetis CJ, Johnson DE, Chong C, et al. Adjuvant cy-clophosphamide, doxorubicin and cisplatin chemotherapy for bladder cancer: an update. J Clin Oncol 1988; 6: 1590–1596PubMedGoogle Scholar
  48. 48.
    Soloway MS. Learning to intergrate systemic chemotherapy into a treatment plan for patients with advanced bladder cancer. J Urol 1985; 133: 440–441PubMedGoogle Scholar
  49. 49.
    Sternberg CN, Yagoda A, Scher HI, et al. Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium: efficiency and patterns of response and relapse. Cancer 1989; 64: 2448–2458PubMedCrossRefGoogle Scholar
  50. 50.
    Scher HI, Yagoda A, Herr HW, et al. Neoadjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) effect on the primary bladder lesion. J Urol 1988; 139: 470–474PubMedGoogle Scholar
  51. 51.
    Tannock I, Gospodarowicz M, Connolly J, et al. MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy for transitional cell carcinoma: the Princess Margaret Hospital experience. J Urol 1989; 142: 289–292PubMedGoogle Scholar
  52. 52.
    Studer VE, Bacchi M, Biedermann C, et al. Adjuvant cisplatin chemotherapy following cystectomy for bladder cancer: results of a prospective randomized trial. J Urol 1994; 152: 81–84PubMedGoogle Scholar
  53. 53.
    Shipley WU, Kaufman SD, Prout GR Jr. The role of radiation therapy and chemotherapy in the treatment of invasive carcinoma of the urinary bladder. Semin Oncol 1988; 15: 390–395PubMedGoogle Scholar
  54. 54.
    Blandy JP, England HR, Evans SJ, et al. T3 bladder cancer: the case for salvage cystectomy. Br J Urol 1980; 52: 506–510PubMedCrossRefGoogle Scholar
  55. 55.
    Wallace DM, Bloom HJG. The management of deeply invasive (T3) bladder carcinoma: controlled trial of radial radiotherapy and radical cystectomy. Br J Urol 1976; 48: 587–594PubMedCrossRefGoogle Scholar
  56. 56.
    Given RW, Parsons JT, McCarley D, et al. Bladder-sparing multimodality treatment of muscle-invasive bladder cancer: a five-year follow-up. Urology 1995; 46: 499–505PubMedCrossRefGoogle Scholar
  57. 57.
    Fitzpatrick JM, West AB, Butler MR, et al. Superficial bladder tumors (stage pTa grades 1 & 2): the importance of recurrence pattern following initial resection. J Urol 1986; 135: 920–922PubMedGoogle Scholar
  58. 58.
    Parmar MKB, Friedman LS, Hargreave TB, et al. Prognostic factors for recurrence follow-up policies in the treatment of superficial bladder cancer: report from the British Medical Research Council subgroup on superficial bladder cancer. J Urol 1989; 142: 284–288PubMedGoogle Scholar
  59. 59.
    Morris SB, Gordon EM, Shearer RJ, et al. Superficial bladder cancer: how long should a tumor-free patient have check cystoscopies? Br J Urol 1995; 75: 193–196PubMedCrossRefGoogle Scholar
  60. 60.
    Holmäng S, Hedelin H, Anderström C, et al. The relationship among multiple recurrences, progression, and prognosis of patients with stages Ta and Tl transitional cell car-cinoma of the bladder followed for at least 20 years. J Urol 1995; 153: 1823–1827PubMedCrossRefGoogle Scholar
  61. 61.
    Booth CM, Kellett MJ. Intravenous urography and the follow-up of carcinoma of the bladder. Br J Urol 1981; 53: 246–249PubMedCrossRefGoogle Scholar
  62. 62.
    Miller EB, Eure GR, Schellhammer PF, et al. Upper tract transistional cell carcinoma following treatment of superficial bladder cancer with BCG. Urology 1993; 42: 26–30PubMedCrossRefGoogle Scholar
  63. 63.
    Wolinska WH, Melamed MR, Schellhammer PF, et al. Urethral cytology following cystectomy for bladder carcinoma. Am J Surg Pathol 1977; 1: 225–234PubMedCrossRefGoogle Scholar
  64. 64.
    Montie JE. Follow-up after cystectomy for carcinoma of the bladder. Uro Clin North Am 1994; 21: 639–643Google Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Roger B. Watson
  • Howard J. Korman
  • Mark S. Soloway

There are no affiliations available

Personalised recommendations