NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please Note These guidelines are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. These guidelines are copyrighted by the National Comprehensive Cancer Network. All rights reserved. These guidelines and the illustrations herein may not be reproduced in any form without the express written permission of the NCCN © 2009. Disclosures for the NCCN Bladder Cancer Guidelines Panel At the beginning of each NCCN guidelines panel meeting, panel members disclosed any financial support they have received from industry. Through 2008, this information was published in an aggregate statement in JNCCN and on-line. Furthering NCCN's commitment to public transparency, this disclosure process has now been expanded by listing all potential conflicts of interest respective to each individual expert panel member. Individual disclosures for the NCCN Bladder Cancer Guidelines Panel members can be found on page 39. (To view the most recent version of these guidelines and accompanying disclosures, visit the NCCN Web site at www.nccn.org.) These guidelines are also available on the Internet. For the latest update, please visit www.nccn.org. 8 Overview An estimated 68,810 new cases of urinary bladder cancer will be diagnosed in the United States (51,230 men and 17,580 women) in 2008. 1 Bladder cancer is the fourth most common cancer in men and is 3 times more common in men than in women in the United States. Furthermore, approximately 14,100 deaths (9950 men and 4150 women) from bladder cancer are anticipated. 1 Bladder cancers are rarely diagnosed in individuals younger than 40 years. Because the median age at diagnosis is 65 years, medical comorbidities are a frequent consideration in patient management. The clinical spectrum of bladder cancer can be divided into 3 categories that differ in prognosis, management, and therapeutic aims. The first c...

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Background Individual variation in circulating insulin-like growth factor-I (IGF1) and its major binding protein, insulin-like growth factor binding protein-3 (IGFBP3) have been etiologically linked to several chronic diseases, including some cancers. Factors associated with variation in circulating levels of these peptide hormones remain unclear. Methods Multiple linear regression models were used to determine the extent to which socio-demographic characteristics, lifestyle factors, personal and family history of chronic disease, and common genetic variants, the (CA)n repeat polymorphism in the IGF1 promoter and the IGFBP3 -202 A/C polymorphism (rs2854744) predict variation in IGF1 or IGFBP3 serum levels in 33 otherwise healthy African American and 37 white males recruited from Durham Veterans Administration Medical Center. Results Predictors of serum IGF1, IGFBP3 and the IGF1:IGFBP3 molar ratio varied by race. In African Americans, 17% and 28% of the variation in serum IGF1 and the IGF1:IGFBP3 molar ratio, respectively, was explained by cigarette smoking and carrying the IGF1 (CA)19 repeat allele, respectively. Not carrying at least one IGF1 (CA)19 repeat allele and a high BMI explained 8% and 14%, respectively, of the variation IGFBP3 levels. These factors did not predict variation of these peptides in whites. Conclusion If successfully replicated in larger studies, these findings add to recent evidence suggesting known genetic and lifestyle chronic disease risk factors influence IGF1 and IGFBP3 circulating levels differently in African Americans and whites.

An estimated 61,420 new cases of urinary bladder cancer will be diagnosed in the United States in 2006, making it the fourth most common cancer in men and the ninth most common neoplasm in women. Because the median age of diagnosis is 65 years, medical comorbidities are a frequent consideration. The clinical spectrum of bladder cancer can be divided into 3 categories: noninvasive tumors, invasive lesions, and metastatic lesions. These categories differ in prognosis, management, and therapeutic goals, and these guidelines discuss management strategies to achieve the best possible outcomes. For the most recent version of the guidelines, please visit NCCN.org

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