Which of the following statement(s) are true concerning bladder carcinoma?

a. Epidemiologic studies have implicated cigarette smoking as a risk factor

c. Multi-focal and recurrent bladder tumors are usually treated with transurethral resection and intravesical chemotherapy

A wealth of basic research and clinical data testify to a variety of chemical carcinogens inducing bladder cancer. Occupational exposure to beta-naphthylamine and para-aminophenyl results in an increased incidence of bladder cancer. Epidemiologic studies have also indicated cigarette smoke as a risk factor. Bladder cancer has a strong male prevalence and is almost three times more common in men than women. The hallmark of bladder cancer is painless, total gross hematuria. The usual diagnostic tests employed are excretory urography (IVP) and cystoscopy. The former is important because the upper tracts (renal pelvises and ureters) are also at risk for the development of urothelial neoplasia. Cystoscopy is not only diagnostic but also therapeutic because superficial tumors are easily excised or fulgurated through endoscopic instruments. Approximately 70% of patients with bladder cancer will present with local disease. This is associated with five year adjusted survival rate of 88%. Close vigilance is important because the recurrence rate exceeds 50%. Ten to 50% of superficial tumors will progress to invasive disease. Multifocal and recurrent tumors are usually treated with intravesical chemotherapy in addition to transurethral resection. Agents commonly employed include thiotepa, doxorubicin, and mitomycin C. Alternatively intravesical immunotherapy has been successfully performed with installation of BCG (Bacillus Calmette-Guerin). Locally advanced tumors are usually treated with radical cystectomy and urinary diversion. Radiation therapy has been employed but is associated with a high rate of local recurrence.