Bladder Cancer at Lake Health 2011
Bladder cancer is the fourth most common cancer found in men in the United States. 69,250 new cases of bladder cancer are diagnosed each year in the United States with 14,990 deaths annually.
In recent decades the overall incidence of bladder cancer has been rising however the death rate has been decreasing such that there are 500,000 survivors of bladder cancer in the United States.
Bladder cancer is three times more common in men than women and is a disease of older individuals with greater than 90% of diagnoses in patients more than 55 years of age. Although uncommon, bladder cancer can occur in young adults and even in children.
Transitional cell carcinoma is the most common pathologic subtype of bladder cancer and is observed in over 90% of tumors. Bladder cancer is staged according to AJCC criteria as:
- TX: Primary tumor cannot be assessed
- Ta: Noninvasive papillary carcinoma
- Tis: Carcinoma in situ
- T1: Tumor invades lamina propria
- T2: Tumor invades muscularis propria (subdivided into T2a and T2b)
- T3: Invades perivesical tissue/fat (subdivided into T3a and T3b)
- T4: Tumor invades prostate, uterus, vagina, pelvic wall, or abdominal wall (subdivided into T4a and T4b)
In most cases of nonmuscle invasive bladder cancer (localized, Ta, Tis, T1 comprising 75% of tumors) are treated initially with transurethral resection (TURBT). All bladder tumors have a high rate of recurrence after TURBT but the risk of stage progression, particularly for low-grade papillary Ta tumors, is low (less than 5%).
Because of the greater chance of progression in Tis and T1 tumors, adjuvant intravesical immunotherapy or chemotherapy can be used in an adjuvant fashion or as part of a maintenance regimen to prevent recurrence and/or progression of the disease.
For stage T2a – T2b N0 M0 and stage III disease T3a – T3b, T4a N0 M0 i.e. invasive into muscle without evidence of extension into surrounding organs or metastatic to lymph nodes or distant organs, radical cystectomy with extended lymphadenectomy is the standard treatment. Reconstruction may be performed either by an ileal conduit or bladder replacement.
External beam radiotherapy (XRT) as part of a multimodality bladder-preserving approach with “radical” TURBT, XRT and chemotherapy can be used for select cases accompanied by close surveillance.
For Stage Tany Nplus Mplus (disease that has spread to lymph nodes and/or is metastatic) platinum based combination chemotherapy prolongs survival.
For 2008-2009 Lake Health recorded 105 cases of bladder cancer. The age distribution was from 50 to 99, with 92% of cases being age 60 to 90 y.o., slightly higher than the national distribution of 77% where there were more cases at each end of the curve. There was a similar almost 3 to 1 distribution of males to females compared to the national database.
75% of Lake Health cancers were localized (Stage 0 and I, Ta, Tis and T1) and nationally it was 67%. 11% were locally advanced (Stage II and III, T2 and T3), 16% nationally and 3% were advanced (stage IV, Nplus and/or M+), 6% nationally (12% and 10% were unknown for Lake Health and nationally, respectively).
Local treatment (TURBT) occurred in 86% of Lake Health System patients but is recorded as only 71% nationally. Radiation therapy (XRT) was added to/used alone in 7% of patients and not recorded in the national database. Chemotherapy was recorded as added to surgery in 6% of Lake Health and 9% nationally.
Overall survival for year one to five for Lake Health vs. the national data were (79%,73%,66%,61%,64%) and (86%,78%,72%,67%,63%) respectively.
In summary, Lake Health demographic profile, treatments provided, and patient outcomes closely match national statistics. There is incomplete capture of all bladder cancer cases that occur in our county due to treatment at non Lake Health System facilities (Mentor Surgery Center, and out of county facilities).