Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Bladder


Related Terms

  • Bladder Cancer
  • Bladder Carcinoma
  • Cancer of the Bladder
  • Cancer of the Urinary Bladder
  • Carcinoma of the Bladder

Differential Diagnosis

Specialists

  • Oncologist
  • Pathologist
  • Radiologist
  • Urologist

Comorbid Conditions

Factors Influencing Duration

Factors that might influence the length of disability include the extent of the disease at initial diagnosis, type of treatment, and complications of treatment. Age at the time of diagnosis may be a factor since older individuals require longer recovery times from treatment. The expected length of disability is increased when radiation and/or chemotherapy is used.

Medical Codes

ICD-9-CM:
188.0 - Neoplasm, Trigone of Urinary Bladder, Malignant
188.1 - Neoplasm, Dome of Urinary Bladder, Malignant
188.2 - Neoplasm, Lateral Wall of Urinary Bladder, Malignant
188.3 - Neoplasm, Anterior Wall of Urinary Bladder, Malignant
188.4 - Neoplasm, Posterior Wall of Urinary Bladder, Malignant
188.5 - Malignant Neoplasm of Bladder; Bladder Neck, Internal Urethral Orifice
188.8 - Neoplasm, Other Specified Sites of Bladder, Malignant
188.9 - Malignant Neoplasm of Bladder, Part Unspecified; Bladder Wall NOS
233.7 - Carcinoma in Situ of Bladder

Overview

Bladder cancer occurs when abnormal cell growth forms extra tissue (lesions) in the hollow sac (urinary bladder) that stores urine before it is voided. The cells keep dividing until the extra tissue becomes a growth or tumor, which can be non-cancerous (benign) or cancerous (malignant). A malignant tumor may spread when abnormal cells invade surrounding tissue or travel to other organs forming secondary tumors.

Most bladder cancer occurs in the bladder's inner lining (transitional epithelium), a mucous membrane composed of transitional cells that expand and contract. Transitional cells line the entire urinary tract, from the kidneys, through the ureters, and into the bladder and urethra. If bladder cancer develops, the entire tract will require clinical evaluation. Bladder cancer is the most common cancer of the urinary tract, and transitional cell cancer (TCC) makes up greater than 90% of malignant cancer of the bladder (Steinberg). Occasionally, a bladder tumor is composed of squamous cells; squamous cell carcinoma (SCC) is a highly invasive cancer with a poor prognosis. Four percent of bladder cancer is caused by squamous cell carcinoma and 1% to 2% by adenocarcinoma.

Most bladder cancers grow slowly. Some will eventually grow from the inner lining and invade the wall of the bladder, and up to 5% will present with invasive cancer, metastasizing to other organs (Steinberg).

Risk factors include chronic infections with the parasite Schistosoma hematobium found in Asia, Africa, and South America; and treatment with the anticancer drug cyclophosphamide. A genetic predisposition to develop bladder cancer may also exist that allows some individuals to more readily metabolize certain causative chemicals.

Incidence and Prevalence: Bladder cancer is the fourth most common cancer in men, and the ninth most common cancer in women in the US ("Detailed Guide"). Approximately 63,210 new cases are predicted for 2005 with about 13,180 deaths, of which 50% are individuals greater than 72 years old; men have a lifetime risk for developing bladder cancer of 1 in 30, and females a lifetime risk of 1 in 90 ("Detailed Guide"). Similar to the US, in developed countries 90% of bladder cancers are TCC. However, in developing countries, 75% of bladder cancers are squamous cell carcinomas, mostly secondary to infection from the Schistosoma hematobium parasite (Steinberg).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who smoke cigarettes are at 2 times greater risk for developing bladder cancer than non-smokers due to the constant excretion of tobacco tars; this is the most important of all the risk factors ("Detailed Guide"). Risk of bladder cancer is higher among workers who experience inhalation exposure to aromatic amines (aniline dyes) used in the rubber, leather, paint, dyes, printing, and textile industries.

Bladder cancer is 2 times more common among whites than blacks, and 4 times more common in men than women ("Detailed Guide"). The incidence of bladder cancer tends to increase sharply with age; approximately two-thirds of the cases occur in individuals 65 and older.

Source: Medical Disability Advisor



Diagnosis

History: Blood in the urine (hematuria) is usually the first symptom. Other symptoms may include a painful, burning sensation in the genitalia, although pain on urination does not usually occur until later in the course of the disease. If the cancer has metastasized to other organ systems, the individual may report weakness, loss of energy (asthenia), loss of appetite (anorexia), and weight loss. They may also report difficulty in breathing or symptoms of chest pain if the cancer has spread to the lungs; or bone pain if it has metastasized to the bones. The individual may have had bladder or kidney infections or a diagnosis of shistosomiasis prior to the current problem. The individual may self-report cigarette smoking.

Physical exam: Individuals appear fairly normal on physical examination. If the cancer is advanced, the individual may appear to have decreased physical vigor and mental activity. Abdominal tenderness may be present and hard spots (indurations) or palpable masses may be found.

Tests: Routine urological evaluation will include examining cells in the urine (urine cytology) and performing a urine culture to determine if any organisms are causing urinary tract infection. Abdominal ultrasound may be performed to visualize lower abdominal organs. Direct visual examination of the bladder (cystoscopy or endoscopy) may be performed using a telescoping fiberoptic device (cystoscope or flexible endoscope) with a tiny camera attached. Examination of the bladder, bladder-neck, and urethra may reveal a lesion (tumor) or multiple tumors. A sample of tissue from the tumor (biopsy) may be taken during this examination to grade the tumor by determining cell type and the extent of abnormality. An intravenous pyelogram (IVP) may be performed by taking a specialized x-ray after administration of a contrast agent directly into the bladder to visualize the entire urinary tract and evaluate bladder size, structure, and function as well as to screen for the presence of tumors. Tumor cells may also be obtained by flow cytometry, the flushing of cells from the bladder walls with fluid (bladder washing) and then examining stained cells under the microscope to analyze chromosomes (DNA ploidy analysis). If the tumor is found to be malignant the cancer will be staged (stages I, II, III, or IV) with regard to its invasiveness. CT, chest x-ray, and MRI may be used to determine if metastasis has occurred, and which organ systems may be affected. Tumor markers for bladder cancer may be identified in the blood or urine with appropriate laboratory tests; markers include carcinoembryonic antigen (CEA), polyamines, and fibrin degradation products (FDP). If the cancer is advanced, a bone scan may be performed in the nuclear medicine laboratory by injecting radioisotopes that travel through the blood and are absorbed by bone. This allows images of bone to be evaluated on a computer screen where abnormalities will be visualized.

Source: Medical Disability Advisor



Treatment

Treatment for bladder cancer depends on the stage of the disease and the general health of the individual. Superficial tumors confined to the bladder lining will likely be removed by transurethral resection (TUR), performed either electrosurgically or as a laser procedure. Bleeding is the most common complication of TUR although perforation of the bladder wall can also occur. Laser surgery minimizes bleeding although electrosurgery is often preferred because it allows more precise grading and staging of the tumor. Approximately 70% of bladder tumors are superficial at the time of diagnosis (Steinberg). Additional therapy may include chemotherapy with either a single cytotoxic drug or a combination of cytotoxic drugs. Intravesical chemotherapy may also be used, applying the cytotoxic drugs directly to the inside of the bladder through a catheter and leaving them there for several hours. Treatment to increase the individual's immune response (Bacille Calmette-Guerin or BCG), may be used to decrease recurrence and prevent tumor progression. These agents are also delivered directly into the bladder 1 time per week for a period of 6 weeks.

Surgical removal of all or part of the bladder (cystectomy) may be necessary to treat metastatic cancer that has already invaded the bladder muscle. Complete bladder removal leads to loss of bladder function and possibly sexual function. Cystectomy may include removal of all anterior pelvic organs in addition to the bladder (radical cystectomy). A new way must then be found to store urine and to remove it from the body. In some cases a diversion is created through which urine will be collected and then passed (cutaneous urinary diversion, continent catheterizing pouch, or orthoptic voiding diversion). Another solution is urostomy, which uses a piece of small intestine to transfer urine directly from the kidneys and ureters through a hole created in the skin (ileal conduit) into an external collection bag. A special form of continent urinary diversion reconstructs an internal pouch using a piece of the individuals large intestine; this creates a urinary reservoir (neobladder) attached to the urethra so both men and women can experience normal urination. Another type of continent diversion allows urine to drain into an internal pouch and a catheter is placed through a hole in the skin into the pouch so the individual won't need an external bag.

Metastatic cancer that has already metastasized to local pelvic lymph nodes is usually treated with cystectomy and removal of the lymph nodes (pelvic lymphadenectomy) combined with chemotherapy. For individuals who may not tolerate radical surgery, treatment with external radiation alone (radiotherapy) or in combination with chemotherapy (chemoradiotherapy) may be appropriate.

Novel therapeutic strategies may include the use of antibodies to carry high activity radiation to the bladder tumor (radioimmunotherapy or RIT). Gene therapy is another new treatment approach aimed at correcting the specific molecular abnormality that gave rise to the disease.

Source: Medical Disability Advisor



Prognosis

The predicted outcome for treatment of bladder cancer depends on the extent of the disease at initial diagnosis and the choice of treatment. The majority of bladder cancers can be treated successfully by TUR; 50% of individuals treated with TUR will survive 5 years (Montie 2068). However, there is a 30% risk of cancer recurrence following TUR; if bladder cancer recurs, a cystectomy must be performed ("Detailed Guide"). BCG treatment that enhances the immune response may decrease the incidence of recurrence to roughly 50% ("Detailed Guide"). If BCG treatment fails, intravesical (inside the bladder) chemotherapy produces a good response rate in 20% of individuals (Steinberg). Radiation therapy has a 5-year survival rate of 20% to 40% if the tumor has invaded the muscle (Eggener). Radical cystectomy to remove the entire bladder and other pelvic organs may lead to significant mortality in 2% of individuals, and morbidity in 27% of individuals receiving this treatment (Eggener). Partial cystectomy has a higher recurrence rate of 38% to 78% but lower mortality and morbidity (Feng).

Individuals whose cancer has invaded the muscle of the bladder have a 5-year survival rate of 65% to 75% despite receiving surgical treatment ("Detailed Guide"). Virtually all individuals with metastatic bladder cancer succumb to the disease within 2 years of diagnosis despite chemotherapy and/or radiation therapy treatments. Radioimmunotherapy has not been found effective in the delivery of lethal doses of radiation to bladder tumors.

Source: Medical Disability Advisor



Rehabilitation

Several types of rehabilitation may benefit individuals recovering from bladder cancer or bladder cancer surgery. Supportive rehabilitation allows individuals to gain some control over the ordinary activities of life and helps them cope emotionally. This may include group vocational rehabilitation to help the individual transition back into the workplace or a return to school and/or retraining if the individual cannot physically return to the previous workplace and career. Palliative rehabilitation addresses pain, allows some level of physical comfort, and provides emotional support and assistance in day-to-day functioning. Physical therapy allows individuals to regain strength and stamina that were lost due to the disease process and during treatment.

Source: Medical Disability Advisor



Complications

Complications of bladder cancer may include infection, bleeding, and obstruction of urinary flow. Some forms of treatment can lead to loss of bladder control and sexual function. Bladder cancer can metastasize into lymphatic system or other organ systems including the lungs, circulatory system, bone, and gastrointestinal system. Reconstructive techniques used for urine storage and removal from the body can cause bowel obstruction and blood clots, especially in severely compromised individuals.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals whose bladder cancer is detected and successfully treated in the early stages usually have minimal work restrictions or accommodations following recovery and return to work. However, duties at work may be restricted and should not include heavy lifting or hard physical labor following surgery, chemotherapy, and/or radiation therapy until recovery is complete. Bathroom facilities should be readily available, as the individual may have to urinate frequently. Fatigue may create the need for additional breaks during the period of recovery. Metastatic cancer is usually associated with permanent disability.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was the diagnosis of bladder cancer confirmed?
  • Did the surgery remove all the cancerous tissue?
  • Has the tumor metastasized into other organ systems?
  • Were underlying conditions identified or ruled out? If present, are they being appropriately addressed?

Regarding treatment:

  • Did individual receive chemotherapy or BCG in addition to surgery? Would it be a useful adjunct to treatment at this time?
  • Because surgical removal of all or part of the bladder (cystectomy) can be physically and emotionally traumatic, would individual benefit from supportive counseling?
  • If the cancer has metastasized to local pelvic lymph nodes, what treatment route has individual undergone (pelvic lymphadenectomy, chemotherapy, radiotherapy, chemoradiotherapy)? Is it now appropriate to add or change modalities?
  • Is individual a candidate for one of the newer treatment strategies such as antibodies to carry high activity radiation to the bladder tumor (RIT) or gene therapy?

Regarding prognosis:

  • Did recurrence of the bladder tumor occur?
  • Because adjuvant chemotherapy or BCG treatment to enhance the immune response may decrease the incidence of recurrence to approximately 50%, would this be a useful adjunct to treatment at this time?
  • Does individual have a realistic concept of prognosis?
  • Does individual have a supportive family or friends?
  • Would counseling be beneficial?
  • Because continued smoking may increase the risk of recurrence or invasion and decrease the rate of remission, was individual warned about the risk of continued smoking?

Source: Medical Disability Advisor



References

Cited

"Detailed Guide: Bladder Cancer." American Cancer Society. 1 Feb. 2005 <http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=44>.

Eggener, Scott E., and Steven C. Campbell. "Cystectomy, Radical." eMedicine. Eds. Richard A. Santucci, et al. 10 Nov. 2004. Medscape. 1 Feb. 2005 <http://emedicine.com/med/topic3061.htm>.

Feng, Adrian H., and Martin Resnick. "Cystectomy, Partial." eMedicine. Eds. Gamal Mostafa Ghoniem, et al. 1 Oct. 2004. Medscape. 1 Feb. 2005 <http://emedicine.com/med/topic3043.htm>.

Montie, James, David C. Smith, and Howard Sandler. "Carcinoma of the Bladder." Clinical Oncology. Eds. Martin D. Abeloff, et al. 3rd ed. Philadelphia: Churchill Livingstone, Inc., 2004. 2059-2079.

Steinberg, Gary David, et al. "Bladder Cancer." eMedicine. Eds. Jong M. Choe, et al. 3 Nov. 2004. Medscape. 1 Feb. 2005 <http://emedicine.com/med/topic2344.htm>.

Source: Medical Disability Advisor






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