Urology>>>>>Bladder Cancer
Question 1#

Regarding bladder cancer, the following statements are true EXCEPT?

A) The estimated male:female ratio is 2:1
B) At the initial diagnosis of bladder cancer, 75% of cases are diagnosed as non-muscle-invasive bladder cancer and approximately 25% as muscleinvasive disease
C) Approximately one-third of patients diagnosed with muscle-invasive disease have undetected metastasis at the time of treatment of the primary tumour
D) 25% of patients subjected to radical cystectomy present with lymph node involvement at the time of surgery

Correct Answer is A

Comment:

Answer A

The estimated male: female ratio for bladder cancer incidence is 3.8:1. However, women are more likely to be diagnosed with primary muscle-invasive disease than men. In a series of patients undergoing radical cystectomy for de novo muscle-invasive TCC, women were more likely to be diagnosed with muscle invasion primarily than men (85.2% and 50.7% respectively), probably as a lot of these women present with UTI’s or irritative LUTS and are treated as such. Women are also more likely to be older than men when diagnosed, with a direct effect on their survival. In addition, delayed diagnosis is more likely in women after haematuria is observed because the differential diagnosis in women includes diseases more prevalent than bladder cancer.

The incidence rate of bladder cancer is highest in developed countries. 63% of all bladder cancer cases occur in developed countries with 55% from North America and Europe. There is a geographic difference in bladder cancer incidence rates across the world with the highest in Southern and Eastern Europe, parts of Africa, Middle East and North America and the lowest in Asia and underdeveloped areas in Africa. The incidence peaks in the seventh decade of life.

Superficial bladder cancer is much more common than muscle-invasive bladder cancer. However, among patients treated with radical cystectomy because of muscle-invasive disease, 57% had muscle invasion at presentation, while 43% had been initially diagnosed with non-muscle-invasive disease that progressed despite organ-preserving treatment. 

Further Reading:

  1. Ploeg M, Aben KK, Kiemeney LA. The present and future burden of urinary bladder cancer in the world. World J Urol 2009; 27: 289–229.
  2. Vaidya A, Soloway MS, Hawke C, et al. De novo muscle-invasive bladder cancer: Is there a change in trend? J Urol 2001; 165(1): 47–50.