Metastatic bladder Cancer
Metastatic Bladder cancer is generally transitional. Patients usually have hematuria which is the most common symptom or irritative disorders related to bladder emptying such as frequency or urgency, subsequently urinary obstruction can cause pain. The diagnosis is based on cystoscopy with biopsy. Treatment consists of electrocution, transurethral resection, intravesical instillations, radical surgery, chemotherapy or a combination of these.
Every year, in the United States, there are more than 70,000 new cases of bladder cancer and about 15,000 deaths. Bladder cancer is in 4th place among the most frequent neoplasms in humans, while it is less common among women. The ratio of men and women is about 3 to 1. Bladder cancer is more common among whites than black people and the incidence increases with age.
The risk factors include the following:
- Smoke -Smoking is the most frequent risk factor.
- Excessive use of phenacetin
- Long-term use of cyclophosphamide
- Chronic irritation for example: bladder stones)
- Exposure to hydrocarbons, metabolites of tryptophan or industrial chemicals
Metastatic bladder icd 10:
ICD-10 is a coding system used by doctors to diagonse Cancer. The coding symtem used for Bladder Cancer is known as metastatic bladder icd 10. So the purpose of ICD 10 code is to classify and code all diagnoses, symptoms and keep a note of the disease.
Bladder Cancer Includes:
Transitional cell carcinomas account for more than 90% of bladder tumors. Most of them are papillary carcinomas, which tend to be superficial, well differentiated and exophytic growth. Sessile tumors are more insidious, tending to invade early and to metastasize.
Squamous cell carcinoma is less frequent and generally occurs in patients with parasitic bladder infection or chronic mucosal irritation.
Adenocarcinoma may present as a primitive tumor or more rarely may represent a metastatic spread from an intestinal carcinoma. Metastases should be excluded.
In more than 40% of patients, the tumor, especially if large, poorly differentiated or if multifocal, can recur at the same place or in other places of the bladder. Bladder cancer tends to metastasize to the lymph nodes, lungs, liver and bones. The expression of mutations in the p53 tumor gene can be associated with disease progression.
Metastatic Bladder Cancer Symptoms
Most patients present with hematuria without identifiable causes. Some patients present with anemia and hematuria are detected during the evaluation. Also an irritative symptomatology during urination and pyuria are frequent at onset. Pelvic pain is present in advanced neoplasms, when a pelvic mass can be palpable.
Metastatic Bladder Cancer Diagnosis
There are two ways to diagnose Netastatic Bladder cancer
- Cystoscopy with biopsy
- Urinary cytology
The suspicion of bladder cancer is clinical. Urinary cytology can be performed to detect the presence of malignant cells.
Cystoscopy with biopsy of abnormal areas is usually performed at the beginning because you can detect cancer cells even if urine cytology is negative. Urinary antigen tests are available but are usually not routinely recommended for diagnosis. They are sometimes used in cases of suspected cancer if the cytological results are negative.
For low-stage cancers, which include 70-80% of bladder tumors, cystoscopy with biopsy is sufficient for staging. However, if the biopsy shows that the tumor is more invasive than a superficial flat tumor, it will therefore be necessary to perform an additional biopsy that also includes muscle tissue. If a tumor is found infiltrating the muscular layer, abdominal and pelvic CT and chest X-ray are performed to establish the extent of the tumor and the presence of metastases. Patients with infiltrating tumors undergo a bimanual examination, while they are under anesthesia for cystoscopy with biopsy.
Metastatic Bladder Cancer Prognosis:
Superficial bladder cancer rarely leads to death. For patients who have a tumor invasion of the bladder muscle wall, the 5-year survival rate is about 50%, but adjuvant chemotherapy can improve these results. Generally, the prognosis of patients with progressive or recurrent invasive bladder cancer is poor. The prognosis of patients with squamous cell bladder cancer is also poor, because these neoplasms are usually highly infiltrating and found only in the advanced stage.
Metastatic Bladder Cancer Treatment:
- Transurethral resection and intravesical chemotherapy (for superficial tumors)
- Cystectomy (for infiltrating tumors)
Superficial tumors:
Superficial tumors can be completely removed by transurethral resection or electrocution. Bladder instillations of chemotherapy drugs, such as mitomycin-C, can reduce the risk of relapse. The instillations can be performed at weekly or monthly intervals for a period of 1 or 2 years.
Infiltrating tumors
Tumors that infiltrate the muscular wall of the bladder usually require a radical cystectomy means removal of the bladder and adjacent structures with a concomitant urinary diversion. Cystectomy is performed more and more frequently after initial chemotherapy in patients with locally advanced disease.
Protocols for bladder preservation that combine chemotherapy and radiotherapy may be indicated for the elderly or for those patients who refuse the most aggressive intervention. These protocols can reach a 5-year survival rate of 20-40%.
The patient should be checked every 3-6 months for disease progression or recurrence.
Metastatic and recurrent tumors
Metastases require chemotherapy treatment, which is often effective but rarely resolutive, unless the metastases are confined to the lymph nodes. Combined chemotherapy can prolong life in patients with metastatic lesions.
Treatment of tumor recurrence depends on the stage of the disease and the site of recurrence, as well as the previous treatment. Recurrence after transurethral resection of superficial tumors is usually treated with a 2nd resection or electrocoagulation.
