Published 2018-07-26
Akhmad Mustafa Ferry Safriadi


Objective: The aim of this study is to provide database about local invasion and metastasis pattern, as well as the disease characteristics of bladder cancer in Hasan Sadikin Hospital, Bandung. Material & Methods: Between January 2011 and December 2016 there were 321 cases of bladder cancer recorded in our hospital. Of all cases, 106 patients included in this study, with evident of local invasion or distant metastasis either radiologically (contrast abdominal pelvic CT scan) or pathologically. Results: The study group consist of 106 patients (86 men [81.7%], 20 women [28.3%]); with mean age of 56.78 ± 13.19 (4-76) years old. Histopathology findings of transitional cell carcinoma (TCC) consist of 82 (77.3%) patients and the atypical histology features group of 24 (22.7%) patients. Local invasion was found in 99 patients of 321 (30.8%), with the most common organ invasion to the prostate in male (n=38 [35.8%]). Lymph node metastasis were found in 47 patients (44.3%), with the most common nodal metastasis to obturator lymph nodes (n=21 [19.8%]). Distant metastasis was found in 24 patients (22.6%) with the most common site for distant metastasis was the liver (n=12 [11.3%]). In TCC group, 12 patients (63.1%) had a distant organ metastasis with nodal metastasis, whereas in atypical group, majority of the patients with distant organ metastasis (n=5 [83.3%]) had no lymph node involvement. Moreover, in transitional cell group, not all patient (n=17 [73.1%]) had local invasion of the tumor, while all patients with distant organ metastasis in atypical group (n=6 [100%]) had abdominal or pelvic wall invasion (cT4b). Conclusion: TCC is the most common pathology findings and with Prostate is the most common site for local tumor invasion. Obturator lymph nodes is the most common nodal metastasis and liver is the most common site for distant metastasis in bladder cancer. 



Bladder cancer, local invasion, metastasis


Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Cancer Incidence and Mortality Worldwide: IARC Cancer Base. Globocan; 2012.

Ghoneim MA, el-Mekresh MM, el-Baz MA, el-Attar IA, Ashamallah A. Radical cystectomy for carcinoma of the bladder: Critical evaluation of the results in 1,026 cases. J Urol. 1997; 158: 393–9.

Woehre H, Ous S, Klevmark B, Kvarstein B, Urnes T, Ogreid P, et al. A bladder cancer multi-institutional experience with total cystectomy for muscle-invasive bladder cancer. Cancer. 1993; 72: 3044–51.

Kim JK, Park SY, Ahn HJ. Bladder cancer: Analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging. Radiology. 2004; 231(3): 725–31.

Koplay M, Kantarci M, Guven F. Diagnostic accuracy of multidetector computed tomography with multiplanar reformatted imaging and virtual cystoscopy in the assessment of bladder tumors after transurethral resection. J Comput Assist Tomogr. 2010; 34(1): 121–6.

Bartsch GC, Kuefer R, Gschwend JE. Hydronephrosis as a prognostic marker in bladder cancer in a cystectomy only series. Eur Urol. 2007; 51(3): 690–7.

McKibben MJ, Woods ME. Preoperative imaging for staging bladder cancer. Curr Urol Rep. Apr 2015; 16(4): 22. doi: 10.1007/s11934-015-0496-8.

Kundra V. Imaging in oncology from the University of Texas M. D. Anderson Cancer Center. Imaging in the diagnosis, staging, and follow-up of cancer of the urinary bladder. AJR Am J Roentgenol. 2003; 180: 1045.

Paik M, Scolieri M, Brown S, Spirnak P, Resnick M. Limitations of Computerized Tomography In Staging Invasive Bladder Cancer Before Radical Cystectomy. The Journal of Urology. June 2000; 163(6): 1693–6.

Brierley JD. TNM classification of malignant tumors. UICC International Union Against Cancer. 8th ed. Oxford; 2017.

Esrig D, Freeman JA, Elmajian DA. Transitional cell carcinoma involving the prostate with a proposed staging classification for stromal invasion. J Urol. 1996; 156: 1071–6.

Nagele U. The rationale for radical cystectomy as primary therapy for T4 bladder cancer. World J Urol. 2007; 25: 401.

Daneshmand S, Stein JP, Lesser T. Prognosis of seminal vesicle involvement by transitional cell carcinoma of the bladder. J Urol. 2004; 2004: 81–84.

Volkmer BG, Ku¨ fer R, Maier S. Outcome in patients with seminal vesicle invasion after radical cystectomy. J Urol. 2003; 169: 1299–302.

Yang WT. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol. 2000; 175: 759.

Kim SH. Uterine cervical carcinoma: Evaluation of pelvic lymph node metastasis with MR imaging. Radiology. 1994; 190: 807.

Herr HW. Superiority of ratio based lymph node staging for bladder cancer. J Urol. 2003; 169: 943–5.

Kassouf W, Agarwal PK, Herr HW. Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: Analysis of pooled data from MDACC and MSKCC. J Clin Oncol. 2008; 26: 121–6.

Rosenberg JE. Update on chemotherapy for advanced bladder cancer. J Urol. 2005; 174: 14.

Wallmeroth A, Wagner U, Moch H, Gasser T, Sauter G, Mihatsch M. Patterns of metastasis in muscle-invasive bladder cancer (pT2–4): An autopsy study on 367 patients. Urol Int. 1999; 62: 69–75.

Kishi K, Hirota T, Matsumoto K. A clinical and pathological analysis of 87 autopsy cases. J Urol. 1981; 125: 36.

Fetter T, Bogaev J, McCuskey B, Seres J. Carcinoma of the bladder: Sites of metasases. J Urol. 1959; 81: 746–8.

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Department of Urology, Faculty of Medicine/Airlangga University