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INTRODUCTION

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Epidemiology

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Epidemiology
Incidence: 74,690 (male: 56,390; female: 18,300 Estimated new cases for 2014 in the United States) Stage at Presentation:
Stage I: 70%
Stages II/III: 25%
20.7 per 100,000 male and female per year (36.6 per 100,000 men, 8.9 per 100,000 women) Stage IV: 5%
Deaths: Estimated 15,580 in 2014 (male: 11,170; female: 4,410)
Median age: Seventh decade
Male to female ratio: 3:1

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

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Work-up

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Work-up
Stage I H&P, cystoscopy, exam under anesthesia, transurethral resection of the bladder tumor (TURBT), and cytology. Consider CT or MRI of the abdomen and pelvis prior to TURBT if sessile or high grade. Consider upper tract imaging with either CT urogram, retrograde pyelogram, or intravenous pyelogram (IVP). Transurethral biopsy of prostate if clinically indicated
Stages II/III H&P, cystoscopy, exam under anesthesia, TURBT, and cytology. CT or MRI of the abdomen and pelvis prior to TURBT. CT of chest. Consider upper tract imaging with either CT urogram, retrograde pyelogram, or IVP. Bone scan if alkaline phosphatase is elevated or symptoms. Transurethral biopsy of prostate if clinically indicated
Stage IV H&P, cystoscopy, exam under anesthesia, TURBT, and cytology. CT or MRI of the abdomen and pelvis prior to TURBT. CT of chest. Upper tract imaging with either CT urogram, retrograde pyelogram, or IVP. Bone scan if alkaline phosphatase is elevated or symptoms

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Pathology

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Pathology

Transitional cell carcinoma

90–95%

Squamous cell carcinoma

5%

Adenocarcinoma

2%

Small cell carcinoma

1%

Histopathologic evaluation should include a description of cell type(s), whether or not there are areas of differing differentiation and the extent of differentiation, whether the tumor is a micropapillary or nested variant, grade (low [G1] vs. high [G2, G3]), presence or absence of lymphatic invasion, the depth of invasion, and whether or not there is muscle in the specimen. Pathologic grade is important in the management of noninvasive tumors

 

McDougal WS et al. Cancer of the bladder, ureter, and renal pelvis. In: Devita VT, Lawrence TS, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. Philadelphia: Lippincott Williams and Wilkins, 2008

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Expert Opinion

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  1. MVAC is the historic standard of care for systemic therapy of patients with metastatic bladder cancer based on high response rates and cure in a subset of patients. A phase III trial demonstrated that the 2-drug doublet of gemcitabine and cisplatin (GC) and MVAC are similar in response and survival but that GC has a better toxicity profile. A phase III trial compared dose dense or high dose (DD) MVAC (plus granulocyte-colony stimulating factor (G-CSF) on 2 week cycles) to standard MVAC (on a 4-week cycle) ...

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