Invasive Bladder Cancer: Support for Screening

Abstract

Of 297 patients with bladder cancer treated between 1975 and 1981, 90 (30 per cent) had histologic documentation of muscle invasion, 82 of whom (91 per cent) had invasion into the muscle at the time of presentation. Of these 82 patients 51 (62 per cent) had tumor localized to the bladder after clinical staging. Of 36 patients undergoing radical cystectomy 9 (25 per cent) had microscopic pelvic lymph node involvement. Nine patients underwent urinary diversion alone and 31 presented with perivesical or pelvic nodal tumor extension, or distant metastases. Only 8 of the 90 patients (9 per cent) had prior superficial bladder cancer. The mean survival for patients with stage B to C disease at diagnosis was 23 months and for those with stage D tumor it was 11 months. This experience indicates that the majority of patients with advanced bladder cancer are not identified at a stage when definitive therapy offers an excellent prognosis. More resources must be devoted to earlier detection.

Urine and Serum Cathepsin B Concentrations in the Transitional Cell Carcinoma of the Bladder

“…Serum cathepsin B concentrations show significant positive correlation with grading of the TCC (P = 0.02), although urinary cathepsin B concentrations and cathepsin B/creatinine ratio are not significant (P = 0.18 and 0.06). This finding could be supported by the hypothesis that invasive high-grade bladder carcinomas are often associated with lymph node metastase in pelvic chains (25% of all invasive tumors) (16), with distant metastase including lung, liver, bone, neck, and central nervous system (17)(18)(19) and thus show high degree of angioinvasivity. High degree of angioinvasivity leads to the elevated transfer of cathepsin B through vessel wall and increased concentration in serum.…”

Surveillance of urothelial carcinoma

“…19 At their initial presentation, 57% of patients had de novo muscle-invasive disease. These data were compared with older series from the early 1980s by Kaye and Lange 20 and Hopkins et al, 21 which found rates of de 22 Among the 87,978 cases, the stage at diagnosis did not change significantly. In situ (Ta and Tis) cancer incidence increased by 1% per year; local disease (T1, T2a, T2b) incidence decreased by 1% annually; and advanced disease (T3a, T3b, T4, nodal and distant metastases) incidence decreased by 0.74%.…”

Bladder cancer: twenty years of progress and the challenges that remain

“…Although 70% or more of patients are diagnosed with superficial bladder cancer, 80% to 90% of patients with muscle‐invasive cancer already have invasive disease at the time of diagnosis 33,34 . Patients in the latter group account for most of the bladder cancer deaths, because 50% of patients with muscle‐invasive disease already have distant metastasis.…”