To view the graphics that complement this report, or to obtain a paper copy of this report, please contact Dawn Wilson in the public relations office at 252-443-8766 or via e-mail at ddwilson@nhcs.org.

STAGES The staging system of the American Joint Committee on Cancer (AJCC), sometimes also known as the TNM system, is the most common system used for bladder cancer and the system uses at NHCS.

NHCS Staging

In 1999, 29% of the patients were diagnosed at Oa Stage. This is a very early stage of cancer that is only found on the surface of the inner lining of the bladder. This type of bladder cancer is also called papillary transitional cell carcinoma.

Also in 1999, 19% of the bladder cancer patients were diagnosed at the early Stage 1. The cancer had grown through the inner layer of the bladder but had not spread to the thick layer of muscle of the bladder wall or to the lymph nodes or other organs. 23% were diagnosed at Stage 2 which indicated that the muscle wall was involved. 13% were diagnosed at Stage 3 which indicated that the cancer had also spread throughout the fatty layer of tissue surrounding the bladder and may have spread to the prostate in men and the uterus and vagina in women. Finally, 3% of the study group was at Stage 4 which indicated the tumor had spread throughout the bladder into the wall s of the abdomen and pelvis and into the nearby lymph nodes.

As noted in the stages graph, in 2000, 55% of the patients were diagnosed at Oa Stage; 18% at Stage 1; 9% at Stage 3 and 5% at Stage 4. In 2001, only 11% were diagnosed at Stage Oa but 55% were diagnosed at Stage 1. Similar results were found for 2002 and 2003.

TREATMENT

Treatment for bladder cancer depends on the type and stage of the cancer and if it has spread to other parts if the body. For early stages Oa and Stage 1, cancers can often be treated locally without removing the bladder. More advanced cancers often need not only surgery but systemic chemotherapy and radiation. If possible, the surgeon will remove only a part of the bladder in a procedure known as partial cystectomy. Advances in chemotherapy and new surgical techniques are making this possible.

According to the National Health Institute, a radical cystectomy with pelvic lymph node dissection is the standard treatment for patients with invasive bladder cancer. Transurethral Resection (TUR) is used primarily in muscle-invasive bladder cancer but depends on the tumor volume and multifocality.

Radiation Therapy has been reserved for those patients who can not under go surgery due to co-morbid conditions, age or the extent of the disease.

NHCS

During 1999 – 2003, 5% of the diagnosed patients did not receive any surgery. Excisional biopsy with a path specimen was the most documented surgery type for this time period. 100% of the patient is 2001 underwent this procedure. In 2003, 3% of the patients underwent local tumor destruction without path specimen and 3% with path specimen.

In 1999 – 2000, 2% of the patients had a partial cystectomy; 1999, 16% of men has a radical cystectomy and in 2000 and 2002, 9% and 5% respectively of the women with bladder cancer had a radical cystectomy and exenteration.

Chemotherapy

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. From 1999 – 2003, 96% of the study group did not receive systemic chemotherapy as adjunct therapy. In both 2000 and 2002, 5% of the patients received a single agent treatment regime. In 2003, 3% of the patients received a multi-chemotherapy agent regime.

Radiation

Radiation therapy may be used to treat bladder cancer at all stages. External beam radiation therapy, available at NHCS Cancer Treatment Center, uses high energy x-rays to stop the cancer cells from growing

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

NHCS

In the five year period 1999 through 2003, 90% of the patients did not receive immunotherapy. 8% did, however, receive immunotherapy as an adjunct therapy for their bladder cancer.

SURVIVAL RATE

The prognosis for people with stage 0a bladder cancer is excellent. These noninvasive papillary cancers are nearly always cured by appropriate treatment and long-term follow- up care. Although you are likely to develop one or more superficial cancers elsewhere in your urinary system, these new cancers are rarely deeply invasive or life threatening. The 5-year survival rate for stage 0a cancer is better than 95%.

Stage I bladder cancers can be completely removed or destroyed by appropriate treatment with transurethral resection and intravesical immunotherapy with BCG or intravesical chemotherapy. However, over half of these patients eventually develop one or more new bladder cancers, and 20% to 30% will have a cancer that invades the bladder muscle and progresses to a higher stage. The 5-year survival rate for all patients, regardless of tumor grade is, on average, 85%. It will be higher for low-grade tumors and lower for the high grade ones.

As with stage II, the main risk for these patients is undetected distant micro metastases, which may grow larger and become life threatening. The 5-year survival rate for stage III bladder cancer varies from about 30% to 65% depending on the size of cancer deposits present in the tissues next to the bladder and whether the cancer has spread to nearby organs.

For stage IV bladder cancers with distant metastases, options include radical cystectomy, external beam radiation therapy, and systemic chemotherapy, given alone or along with these other treatments. The 5-year survival rate is about 10% to 15%.

NHCS

3% of those patients diagnosed and treated for bladder cancer in 1999 have a 5 year survival rate. Summary

It is estimated that 12,400 Americans will die of bladder cancer in 2004. Females are approximately twice as likely as males to die from the disease because they are usually diagnosed at a later stage then men. Experts from the Department of Urology and pathology at the University of Miami feel that one of the reasons for this is the relative thinness of the elderly female bladder permitting rapid extravesical spread and the older median age at presentation in woman than men. Therapeutic gains in bladder cancer case reduction might be realized from improved education regarding risk factor and the signs and symptoms associated with bladder cancer. Once again, emphasizing not to smoke is key for overall cancer reduction.

Cindy Worthy RN, MSN Vice President Community Outreach