text:
Common Names
Click on the language to view common names.
Common Names in English:
Clubmoss, Bristly Club-Moss, Interrupted Clubmoss, Stiff Club Moss, Stiff Clubmoss
Common Names in French:
Lycopode Interrompu
Common Names in Romanian:
Common Names in Swedish:
Common Names in unspecified:
Clubmoss, Stiff Club Moss, Stiff Clubmoss
Family Lycopodiaceae
, on rock, or epiphytic. Roots
emerging near origin
, or growing through cortex and emergent some distance
from origin. Horizontal stems present or absent, mainly protostelic, in some species becoming actino- or plectostelic, on substrate surface or subterranean
, or forming stolons. Upright shoots
or branched, usually conspicuously leafy at least at base
; abscising gemmae formed by reduced lateral
shoots. Lateral shoots present or absent, simple or branched, branching pattern
dichotomous and sometimes pseudomonopodial; leaves uniform
or dimorphic
or trimorphic. Upright and lateral shoots round
or flat in cross
; leaves on subterranean parts flat, appressed
, nonphotosynthetic, and scalelike; leaves on aerial
parts appressed, ascending
, or spreading
, with 1 central unbranched vein
, needlelike to lanceolate to ovate
, remote
to dense and imbricate, with or without basal and/or mucilage canals. Strobili sessile or stalked
, upright, nodding
, or pendent. Sporangia solitary, adaxial
near leaf base or axillary
; subtending
leaves (sporophylls) unmodified and photosynthetic to much modified, nonphotosynthetic, reduced, and aggregated in strobili; sporangia reniform to globose
, thick-walled with hundreds
of spores, outer walls variously modified. Spores all 1 kind, trilete, thick-walled, surfaces pitted
to small-grooved, rugulate, or reticulate
. Gametophytes subterranean and nonphotosynthetic or surficial
and photosynthetic.
Genera 10--15, species 350--400 (7 genera, 27 species in the flora
) : worldwide.
The Lycopodiaceae are an extremely diverse
, ancient family
. The family may contain even more than the estimated 400 species because the tropical
and the very large genus Phlegmariurus are still poorly known. The relationships
among genera of Lycopodiaceae are not well understood because large evolutionary gaps
exist among most genera. Some of the genera, notably Diphasiastrum, Huperzia, and Lycopodiella, exhibit
extensive interspecific
hybridization, which has caused much taxonomic
confusion in the past. Differences in expressions of many of the generic
characters are subtle, and some of the characters are microscopic.[1]
Genus Lycopodium
mainly trailing
on ground
. Roots
emerging from point
of origin
on underside of main stems
. Horizontal stems on substrate surface or subterranean
, long-creeping. Upright shoots
along horizontal stem, 5--16 mm diam., round
or flat in cross
, unbranched or with 1--4 lateral
. Leaves not imbricate, linear
to linear-lanceolate; leaves on horizontal stems scattered, appressed
, membranous; leaves on lateral branchlets mostly 6-ranked or more, monomorphic
with few exceptions, appressed, ascending
to spreading
, margins
entire to dentate
. Gemmiferous
branchlets and gemmae absent. Strobili single and sessile or multiple
and pedunculate
, apex blunt
to acute; peduncle, when present, conspicuously leafy; sporophylls extremely reduced, much shorter than peduncle or stem leaves. Sporangia reniform
. Spores reticulate
, sides at equator convex
, angles
acute. Gametophytes nonphotosynthetic, mycorrhizal, subterranean, flat and irregularly button-shaped, with ring
meristem around circumference. x
= 34.
Species 15--25: mainly temperate
and subarctic
In striking contrast to Diphasiastrum, Huperzia, and Lycopodiella, interspecific
hybridization is practically unknown in Lycopodium. Many of the species now recognized in Lycopodium have been segregated from Lycopodium clavatum, L. annotinum, and L. jussiaei Desvaux ex
Poiret. The three groups given in the key
below should probably be treated as subgenera
Physical Description
Species Lycopodium annotinum
Horizontal stems on substrate surface. Upright shoots
mainly unbranched or sparsely branching mainly at base
, 1.2--1.6
cm diam.; annual
bud constrictions abrupt
and conspicuous
. Lateral
few and like upright shoots but annual bud constrictions
absent. Leaves spreading
to reflexed
, dark green, linear-lanceolate,
0.6--1.2 mm; margins
closely and shallowly dentate
mainly in distal 1/2; apex sharply pointed
, lacking hair tip
. Strobili
solitary, sessile on shoots, 15--30 X 3.5--4.5 mm.
Sporophylls (1.5--)
3.5 X 0.7(--2) mm, abruptly narrowed to pointed tip. 2 n = 68. [source]
This widespread and common club-moss has been divided
into various
forms or varieties, some of which have been treated as species. Present
evidence supports
the hypothesis
that these are environmentally induced
forms, the most distinctive of which has been called Lycopodium annotinum
var. alpestre C.
Hartman, with leaves only 2.5--6 mm, very leathery,
entire-margined, and appressed
. Plants
intermediate between this
and L. annotinum var. annotinum are a form that has been called var.
pungens (Bachelot de la Pylaie) Desvaux, an invalid name
. Both are
found in cold, bleak, northern or high elevation
. The species
should be studied in detail to determine whether it contains any
groups that should be recognized taxonomically. [source]
Lycopodium clavatum group [source]
Habit: Subshrub , Shrub
Swampy or moist coniferous forests , mountain forests, and exposed grassy or rocky sites; 0--1850 m [3].
Typically found at an altitude of 0 to 2,916 meters (0 to 9,567 feet).[4]
Duration: Perennial
- Domain:
- Whittaker & Margulis,1978
- eukaryotes
- Kingdom:
- Haeckel, 1866
- Plants
- Subkingdom:
- Cavalier-Smith, 1981
- Phylum:
- Sinnott, 1935 ex Cavalier-Smith, 1998
- Vascular Plants
- Subphylum:
- Infraphylum:
- (Auct.) Cavalier-Smith, 1998
- Class:
- Bartl.
- Order:
- Dumortier, 1829
- Family:
- Palisot de Beauvois ex Mirbel, in Lamarck & Mirbel, 1802
- club mosses
- Genus:
- C. Linnaeus, 1753
- Club-moss [Greek lykos, wolf, and pous, podes, foot; in reference to the resemblance of the branch tips to a wolf's paw]
- Specific epithet:
- Botanical name: - Lycopodium annotinum L.
- Specific epithet:
- Genus:
- C. Linnaeus, 1753
- Club-moss [Greek lykos, wolf, and pous, podes, foot; in reference to the resemblance of the branch tips to a wolf's paw]
- Family:
- Palisot de Beauvois ex Mirbel, in Lamarck & Mirbel, 1802
- club mosses
- Order:
- Dumortier, 1829
- Class:
- Bartl.
- Infraphylum:
- (Auct.) Cavalier-Smith, 1998
- Subphylum:
- Phylum:
- Sinnott, 1935 ex Cavalier-Smith, 1998
- Vascular Plants
- Subkingdom:
- Cavalier-Smith, 1981
- Kingdom:
- Haeckel, 1866
- Plants
Lepidotis annotina (L.) P. Beauv. • Lycopodium annotinum alpestre (Hartman) A. & D. Löve • Lycopodium annotinum pungens (La Pylaie) Hultén • Lycopodium annotinum var. acrifolium Fern. • Lycopodium annotinum var. alpestre Hartman • Lycopodium annotinum var. pungens (La Pylaie) Desv. • Lycopodium dubium Zoega
Publishing author
: L. Publication
: Sp.
Pl. 2: 1103 1753 [1 May 1753]
Status: Accepted Name
Last scrutiny: 17-Oct-2001
Similar Species
Members of the genus Lycopodium
ZipcodeZoo has pages for 51 species, subspecies, varieties, forms, and cultivars in this genus:
L. alpinum (Alpine Club Moss) · L. annotinum (Clubmoss) · L. annotinum f. groen;andicum (Clubmoss) · L. annotinum pungens (Stiff Clubmoss) · L. apodum (Meadow Spike Moss) · L. argenteum (Northern Sennet) · L. carinatum (Club Moss) · L. cernua (Lycopodium) · L. circinale (Blackfin Barracuda) · L. clavatum (Common Club Moss) · L. clavatum contiguum (Staghorn Club-Moss) · L. clavatum f. brevipedunculatum (Staghorn Club-Moss) · L. clavatum f. incurvum (Common Club Moss) · L. clavatum f. robustinus (Staghorn Club-Moss) · L. clavatum var. aristatum (Staghorn Club-Moss) · L. clavatum var. clavatum (Running Clubmoss) · L. clavatum var. raddianum (Staghorn Club-Moss) · L. complanatum (Plants) · L. complanatum complanatum (American Clubmoss) · L. complanatum f. canadense (Christmas Green) · L. dendroideum (Tree Groundpine) · L. deuterodensum (Bushy Clubmoss) · L. digitatum (Fan Club-Moss) · L. douglasii (Douglas' Spikemoss) · L. fastigiatum (Mountain Clubmoss) · L. habereri (Haberer's Clubmoss) · L. hickeyi (Hickey's Clubmoss) · L. issleri (Issler's Clubmoss) · L. lagopus (One-Cone Clubmoss) · L. longifolium (Pacific Threadfin) · L. lycopodiella (Lycopodiella) · L. mirabile (Thread-Fishes) · L. nudum (Clubmosses) · L. obscurum (Ground Pine) · L. obscurum f. dendroideum (Flat-Branch Tree Club-Moss) · L. obscurum f. foliaceum (Flat-Branch Tree Club-Moss) · L. obscurum f. parvispicatum (Ground Pine) · L. phlegmaria (Queensland Tassel-Fern) · L. proniflorum (Mullet) · L. pungens (Stiff Clubmoss) · L. sabinaefolium sitchense (Sitka Clubmoss) · L. sabinifolium (Ground-Fir) · L. scariosum (Spreading Clubmoss) · L. sitchense (Alaskan Clubmoss) · L. tristachyum (Deep-Root Clubmoss) · L. venustulum (Hairtip Clubmoss) · L. volubile (Climbing Clubmoss) · L. x habereri (Hybrid) · L. × issleri (Issler's Clubmoss) · L. x zeilleri (Zeiller's Clubmoss) · L. zeilleri (Deeproot Clubmoss)
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Further Reading
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- The geology of New Hampshire: a report comprising the results of explorations ordered by the legislature / C. H. Hitchcock, state geologist. Concord: E. A. Jenks, state printer, 1874-1878. url p. 572.
- The miscellaneous botanical works of Robert Brown. London, Published for the Ray society by R. Hardwicke, 1866-68. url p. 518.
- The morphology of pteridophytes; the structure of ferns and allied plants. London, Hutchinson University Library[1962] url p. 56, p. 62, p. 66.
- The natural history of plants, their forms, growth, reproduction, and distribution; Dublin, Blackie & son, limited, 1902. url , , .
- The natural history of plants; their forms, growth, reproduction, and distribution. From the German of Anton Kerner von Marilaun, by F.W. Oliver, with the assistance of Marian Busk and Mary F. Ewart. with about 2000 original woodcut illustrations and sixteen plates in colours. London, Blackie, 1896-1897. url , p. 714, p. 716, p. 970.
- The natural history of the Toronto region, Ontario, Canada / edited by J.H. Faull. Toronto: Canadian Institute, 1913. url p. 148.
- The naturalist in Norway: or, Notes on the wild animals, birds, fishes, and plants of that country. .. / by Rev. J. Bowden. London: L. Reeve & Co., 1869. url p. 260.
- The naturalist. London: Simpkin, Marshall, 1865- url p. 334.
- The open Polar Sea: a narrative of a voyage of discovery towards the North pole in the schooner "United States" / by Isaac I. Hayes; illustrated by Darley and others. Philadelphia: David McKay, [c1885] url p. 399.
- The orchids in the Ottawa District: floristics, phytogeography, population studies and historical review / Joyce M. Reddoch and Allan H. Reddoch. 111 1997 Ottawa, Canada: The Ottawa Field-Naturalists' Club, [1997] url p. 112, p. 54, p. 78.
- The origin of a land flora, a theory based upon the facts of alternation, London, Macmillan and Co., Ltd., 1908. url , , , .
- The origin of a land flora: a theory based upon the facts of alternation / by F. O. Bower. With numerous illustrations. London: Macmillan, 1908. url p. 210, p. 349, p. 668, p. 686.
- The plants of Prince Edward Island / Ottawa: Research Branch, Agriculture Canada, 1985. url p. 44, p. 45.
- The standard cyclopedia of horticulture; a discussion, for the amateur, and the professional and commercial grower, of the kinds, characteristics and methods of cultivation of the species of plants grown in the regions of the United States a Illustrated with colored plates, four thousand engravings in the text, and ninety-six full-page cuts. New York, Macmillan, 1919 [c1914] url p. 1181.
- The structure and development of mosses and ferns (Archegoniatae) / by Douglas Houghton Campbell. New York: Macmillan, 1928 [c1905] url p. 489, p. 650.
- The vegetable kingdom: or, The structure, classification, and uses of plants, illustrated upon the natural system / by John Lindley. London: Bradbury and Evans, 1846. url p. 69.
- The vegetation of the Siberian-Mongolian frontiers (the Sayansk region) [Trondhjem]K. Norske Videnskabers Selskab[1921] url .
- The vines of northeastern America / by Charles S. Newhall. New York: Putnam, 1897. url , p. 188.
- The vines of northeastern America; New York [etc.]G. P. Putnam's Sons, 1897. url , .
- Through glade and mead; a contribution to local natural history, Worcester, Mass., Putnam, Davis and Company, [c1894] url .
- Torreya. Burlington, Vt., Torrey Botanical Club, 1901-1945. url p. 12, p. 136, p. 143, p. 15, p. 150, p. 172, p. 176, p. 230, p. 26, p. 57, p. 70, p. 82, p. 86.
- Transactions and proceedings of the Botanical Society of Edinburgh. [Edinburgh]: The Society, 1891-1970. url , , p. 283, p. 33, p. 40, p. 49, p. 91.
- Transactions of the Botanical Society. Edinburgh: Botanical Society of Edinburgh, 1841-1891. url p. 390.
- Transactions of the Canadian Institute. Toronto: Canadian Institute. url p. 170, p. 18, p. 267, p. 275, p. 290, p. 397.
- Transactions of the Edinburgh Field Naturalists' and Microscopical Society. [Edinburgh]: The Club, 1891- url p. 253.
- Transactions of the Edinburgh Naturalists' Field Club. Edinburgh: The Club, 1886. url p. 137, p. 137.
- Transactions of the Linnean Society of London, 2nd series: Botany 7 1904-1913 London. url p. 22, p. 34.
- Transactions of the Natural History Society of Glasgow. Glasgow, The Society. url , p. 289.
- Transactions of the Sapporo Natural History Society. Sapporo, Japan, Sapporo Natural History Society, Hokkaido Imperial University. url p. 153, p. 153, p. 159.
- Trees, shrubs and vines of the northeastern United States. .. together with an account of the principal foreign hardy trees, shrubs and vines cultivated in our country, and found in Central Park, New York City by H.E. Parkhurst. New York, C. Scribner's sons, 1903. url p. 442.
- Wild flowers of the North American mountains. New York, McBride, 1917. url p. 373, p. 57.
- Works on forestry [by] J.C. Brown. Edinburgh, Oliver and Boyd; [etc., etc.]1883-87. url p. 190.
- Øllgaard, B. 1990. Lycopodiaceae. In: K. Kubitzki et al., eds. 1990+. The Families and Genera of Vascular Plants. 1+ vol. Berlin etc. Vol. 1, pp. 31--39.
- Øllgaard, B. 1987. A revised classification of the Lycopodiaceae s. lat. Opera Bot. 92: 153--178.
- Øllgaard, B. 1989. Index of the Lycopodiaceae. Biol. Skr. 34: 1--135.
- Wagner, W. H. Jr. and J. M. Beitel. 1992. Generic classification of modern North American Lycopodiaceae. Ann. Missouri Bot. Gard. 79: 676--686.
- Wagner, F. S. 1992. Cytological problems in Lycopodium sens. lat. Ann. Missouri Bot. Gard. 79: 718--729.
- Wagner, W. H. Jr. 1993. A new combination for a North American lycopod. Novon 3: 305.
- Hickey, R. J. 1977. The Lycopodium obscurum complex in North America. Amer. Fern J. 67: 45--49.
- Wagner, W. H. Jr., J. M. Beitel, and R. C. Moran. 1989. Lycopodium hickeyi: A new species of North American clubmoss. Amer. Fern J. 79: 119--121.
- Bisby, F.A., Y.R. Roskov, M.A. Ruggiero, T.M. Orrell, L.E. Paglinawan, P.W. Brewer, N. Bailly, J. van Hertum, eds (2007). Species 2000 & ITIS Catalogue of Life: 2007 Annual Checklist. Species 2000: Reading, U.K.
- Brands, S.J. (comp.) 1989-present. The Taxonomicon. Universal Taxonomic Services, Zwaag, The Netherlands. Accessed January 11, 2012.
- Global Biodiversity Information Facility. Accessed November 26, 2007. http://www.gbif.org Mediated distribution data from 4 providers.
- "Lycopodium annotinum". in Flora of North America Vol. 2. Published by Oxford University Press. Online at EFloras.org.
- Ruggiero M., Gordon D., Bailly N., Kirk P., Nicolson D. (2011). The Catalogue of Life Taxonomic Classification, Edition 2, Part A. In: Species 2000 & ITIS Catalogue of Life: 2011 Annual Checklist (Bisby F.A., Roskov Y.R., Orrell T.M., Nicolson D., Paglinawan L.E., Bailly N., Kirk P.M., Bourgoin T., Baillargeon G., Ouvrard D., eds). DVD; Species 2000: Reading, UK.
- The International Plant Names Index. Accessed Dec 27, 2011.
- USDA, ARS, National Genetic Resources Program. Germplasm Resources Information Network - (GRIN) [Online Database]. National Germplasm Resources Laboratory, Beltsville, Maryland. URL (April 29, 2008)
Data Sources
Accessed through GBIF Data Portal November 19, 2007:
- Jyväskylä University Museum - The Section of Natural Sciences, Vascular plant collection of Jyvaskyla University Museum
- Missouri Botanical Garden, Missouri Botanical Garden
- Oregon State University, Vascular Plant Collection
- The Danish Biodiversity Information Facility, Botany registration database by Danish botanists
- The New York Botanical Garden, Vascular Plant Type Specimens
- The Swedish Museum of Natural History
- , Botany
- The Swedish Museum of Natural History
- , Herbarium of Oskarshamn
- The Swedish Museum of Natural History
- , Plants
- University of Alabama Biodiversity and Systematics, Herbarium
- University of Alaska Museum of the North, University of Alaska Museum of the North Herbarium
- Biodiversity Heritage Library NamebankID: 2644341
- Catalogue of Life Accepted Name Code: ITS-529052
- Global Biodiversity Information Facility Taxonkey: 4490920
- Globally Unique Identifier: urn:lsid:ipni.org:names:1211781-2
- GRIN Nomen Number: 22968
- Integrated Taxonomic Information System (ITIS) Taxonomic Serial Number (TSN): 17018
- International Plant Names Index (IPNI) ID: 304983-2
- Natural Heritage Network Species Identifier: PPLYC01034
- U.S.D.A. Plant Symbol: LYDU
- Zipcode Zoo Species Identifier: 48630
- Warren H. Wagner Jr. & Joseph M. Beitel "Lycopodiaceae". in Flora of North America Vol. 2. Oxford University Press. Online at EFloras.org. [back]
- "Lycopodium". in Flora of North America Vol. 2. Oxford University Press. Online at EFloras.org. [back]
- "Lycopodium annotinum". in Flora of North America Vol. 2. Oxford University Press. Online at EFloras.org. [back]
- Mean = 395.080 meters (1,296.194 feet), Standard Deviation = 378.050 based on 8,388 observations. Altitude information for each observation from British Oceanographic Data Centre. [back]


text:
A Photoshop piece combining vector objects and photo manipulation.
A Photoshop piece inspired by the birth of my friend's daughter.
Wallpaper image created while working at THE boom boom BOYS.
Vector portraits created for two friends.
3D Modelling excersises. These projects are ongoing.
3D rendering of another model I created.

subset: commoncrawl


text:
About TheLoot
It occurs to me... that's there's pretty much no incentive not to lie in situations like this. You tell the truth, you're screwed, sued, and at least out of a job if not going to jail if things were severe enough; no mercy. At least by sticking with a story, people believe they'd have a chance of avoiding punishment.
And neither should be think violent gangs of criminals taking over the roads is OK.
Let's see: The forced accident, breaking of a side mirror, a slashed tire, pounding on the vehicle, and the simple fact of a large, angry group of dangerous and reckless individuals.
I don't know why you're attempting to blame the victim and defend these bike thugs.
Maybe you should fucking shut your mouth and watch the videos and read about the facts. Every comment of yours has been moronic. I'm assuming you were one of these bikers, or someone who knows the, because of that. Bias is the only reason you'd be this stupid.
Maybe you should learn the facts before you spout off.
Don't be a fool. If you're trying to make an analogy, be accurate. Try this: If one of them stopped in front of you and you bumped into them, then they started shoving and yelling at you. They then knock you to the ground and start kicking you in the sides.
Yes, you would be completely justified in your self-defense.
That second "insightful" comment...
I want to bash my brains in... but I guess none of you would call 911 to help me.
How do you tell the good from the bad with ANYONE?
It seems like cops are the ones where it's OK to reduce an entire, diverse group of people to their lowest common denominator, and to be PROUD OF IT.
Any other group and you'd get your face chewed off.
Expected sociopaths in comments. Was not disappointed.
I'm not specifically referring to this story, just about these policies and overzealous enforcement of them in general.
I think one reason for overreactions like these is the overly-litigious way that society has gotten. The schools are afraid that if they don't do EVERYTHING in their power to keep children safe and something happens, parents are going to sue the shit out of the school.
The irony, is of course, that those methods result in lawsuits anyways. Lose-lose, really, and everyone is to blame.
Uh, no one should be defending this one. This kid said he would seriously enjoy killing people. No mention of being joking, no mention of it not being serious, no j/k or LOL.
That copypasta is irrelevant, it's a troll post, and it shows how little he cares about any consequences of his statements.
I don't KNOW if he'd ever act on his apparent desires, but anyone looking at his words should be worried.
Assclowns? Sure, but don't throw "misogyny" around every time an unflattering light is shone on women. It's already hard enough to take that term's use seriously.
How many kids have to stick their fingers in an electrical socket before it becomes clear it's a stupid idea?
While there has been an extreme amount of inappropriate punishment in these situations, these things should not be done without punishment.
Should not be done at all, in fact. There's no good reason to try to make excuses as to why they don't deserve punishment. Fight the sentence, not the sentencing.
No. Want to know why? Shoelaces and chainsaws (contrary to popular belief, they make terrible murder weapons) are tools that have purposes other than bodily harm that they excel at. A gun is a tool with one true purpose: bodily harm and/or death.
A gun is twice as easy to kill with, and twice as likely to give someone the confidence to use it for such purpose. So yes, a crime involving a gun SHOULD be punished more than one not involving one.
You misunderstand. The idea was if a gun was involved in the comission of a crime regardless if it was used or not, not just if the perpetrator owned a gun.
Careful when attempting to redefine "assault" only because it's a police officer. You may be "assaulted" one day and look like an idiot when YOU want to press charges.
Rock and a hard place, this next generation will be.
It'd be safer to say "publisher OR developer". It'd be nice to think that development studios have our best interests in mind, but they have as much incentive to do the same things their publishers do. If they can avoid taking the heat, all the better.
You bring up a very good, very worrying, point. "No used game restrictions" and "no connection required" could fall into the same trap that OtherOS did.


text:
Full Year 2013 - School
Whole of School Approach to Physical Activity
By: Harold W. Kohl, III, Ph.D., PCFSN Science Board Member
The Institute of Medicine (IOM) recently released a report entitled "Educating the Student Body: Taking Physical Activity and Physical Education to School." With funding from the Robert Wood Johnson Foundation, the report committee was tasked with: 1) assessing the status of physical activity and physical education in schools; 2) reviewing the science behind the effects of physical activity on health, development and academic performance in youth; and 3) making recommendations appropriate with the scientific evidence.
PCFSN Announces Expansion of I Can Do It, You Can Do It!
The President's Council on Fitness, Sports & Nutrition announced phase two of the I Can Do It, You Can Do It! (ICDI) program at a Presidential Active Lifestyle Awards (PALA+) ceremony for 1,200 students with disabilities in Miami, Florida.
Let's Move! Active Schools
By: Dominique Dawes, Co-Chair of the President's Council on Fitness, Sports & Nutrition
When I think back to my childhood years, I'm reminded of how fortunate I am to have grown up in a community that placed such a great emphasis on engaging in regular physical activity. I didn't know it at the time, but when I was tumbling at the age of 6, I was doing more than just having a good time – I was also creating healthy habits that will benefit my health and well-being for a lifetime.
- Childhood Obesity (6)
- Disability (3)
- Fitness (15)
- Fitness Tips (1)
- Let's Move! (9)
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- National Physical Fitness and Sports Month (1)
- Nutrition (12)
- Obesity (1)
- Physical Activity (9)
- Physical Education (3)
- President's Council (1)
- School (8)
- Science Board (1)
- Sports (8)
- Title IX (3)
- Worldwide Day of Play (2)
- Youth (12)
Check out
Keep track of all your activities by signing up to earn your PALA+
on twitter
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Keep sneakers with you at work to mix in physical activity throughout the day.
Challenge your muscles by mixing up activities; trying new things keeps it interesting!


text:
I struggle with hills. I am very slow and have to stop to rest my legs and lungs. An ex smoker of 4 months after 40 years explains a lot. But I want to improve, I ride for 3 days on alternate weekends, 80km to 120 each day and include hills such as the Velloway or up into the hills via Gorge road etc. In between my weekends off I commute to the gym 3 days a week (15km each way), do spin 3 times a week on alternate weeks and have just changed my gym routine to include any resistance training that involves legs. So over 14 days I exercise one way or another on at least 10 or 11.
I'd be interested to hear any suggestions on how to further improve my hill climbing or perhaps change what I'm doing.
Tags: climbing
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text:
Diagnosis and Treatment of Bladder Cancer
Am Fam Physician. 2009 Oct 1;80(7):717-723.
Patient information: See related handout on bladder cancer, written by the authors of this article.
This article exempifies the AAFP 2009 Annual Clinical Focus on management of chronic illness.
Bladder cancer is the sixth most prevalent malignancy in the United States. The most common type of bladder cancer is urothelial (transitional cell) carcinoma, and cystoscopy remains the mainstay of diagnosis and surveillance. Fluorescence cystoscopy offers improvement in the detection of flat neoplastic lesions, such as carcinoma in situ. Non-muscle-invasive bladder cancer is typically managed with transurethral resection and perioperative intravesical chemotherapy. Intravesical bacille Calmette-Guérin therapy is preferred over mitomycin for those at high risk of disease progression. For muscle-invasive disease, standard management is radical cystectomy. In these patients, neoadjuvant chemotherapy or postoperative adjuvant chemotherapy should be considered based on pathologic risks, such as positive lymph nodes or pathologic T stage. Multidrug systemic chemotherapy involving cisplatin is commonly used. No major organization recommends screening for bladder cancer.
Bladder cancer is the second most common genitourinary malignancy.1 It is the sixth most prevalent malignancy in the United States, accounting for approximately 7 percent of cancers in men and 3 percent of cancers in women.1,2 Bladder cancer ranges from mild disease with a low mortality rate to extremely high-grade tumors associated with high mortality. It has a clear correlation with environmental exposures, such as smoking. Accurate staging and grading is important to select optimal treatment. This article briefly reviews the epidemiology, pathology, diagnosis, and treatment of bladder cancer, with emphasis on recent developments.
Clinical recommendation | Evidence rating | References |
The U.S. Preventive Services Task Force recommends against routine screening for bladder cancer in adults. |
Patients with symptoms of bladder cancer should be evaluated with cystoscopy and bladder wash cytology. |
Tumor markers should not be used for diagnosis of bladder cancer. |
Fluorescence cystoscopy may be used to enhance the detection of flat neoplastic lesions, such as carcinoma in situ. |
Complete blood count, blood chemistry tests, liver function tests, chest radiography, and CT or magnetic resonance imaging of the abdomen and pelvis should be included in the metastatic workup for invasive bladder cancer. |
All patients with bladder cancer should have an evaluation of the upper urinary tract with intravenous urography, renal ultrasonography, CT urography, or magnetic resonance urography. |
Urine cytology should be used to identify high-grade tumors and monitor patients for persistent or recurrent disease. |
CT = computed tomography.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.xml.
Bladder cancer is the fourth most common cancer in men and the eighth most common in women. In 2007, approximately 50,000 men and 17,000 women were diagnosed with bladder cancer, and there were about 14,000 deaths caused by this disease.1 It is primarily found in older persons, with approximately 80 percent of new cases occurring in persons 60 years or older.2 Bladder cancer is about three times more common in men (one in 27) than women (one in 85). It is more prevalent in white persons; however, because of delayed diagnosis, mortality rates are higher in black persons.3
Risk Factors
The best known behavioral risk factor for bladder cancer is cigarette smoking; it accounts for 50 percent of cases in developed countries.4 Smokers have a four to seven times greater risk of developing bladder cancer than nonsmokers.5,6 In industrialized countries, 5 to 10 percent of bladder cancers are caused by occupational exposures, such as aromatic amines used in the manufacturing of chemical dyes and pharmaceuticals and in gas treatment plants.7,8
Schistosoma haematobium infection, endemic to 50 countries in Africa and the Middle East, is another established risk factor. Seventy percent of S. haematobium-related cancers are squamous cell carcinomas, and the remainder are urothelial (transitional cell) carcinomas.9 Exposure of the bladder to radiation, often as treatment for other pelvic malignancies, increases the risk of bladder cancer five to 10 years after treatment. These cancers tend to be high grade and locally advanced.7 Familial clustering of bladder cancer, especially in relatively young persons, suggests genetic involvement in some cases.8,10 Risk factors for bladder cancer are listed in Table 1.
Table 1 Risk Factors for Bladder Cancer
Risk Factors for Bladder Cancer
Behavioral |
Cigarette smoking |
Chemical exposure |
Arsenic in well water |
Chronic infection |
Bladder calculi, chronic bladder infection, genitourinary tuberculosis, long-term indwelling catheter, schistosomiasis |
Iatrogenic |
Cyclophosphamide (Cytoxan), pelvic radiation therapy |
Occupational |
Exposure to aromatic amines (beta-naphthylamine) used in the manufacturing of chemical dyes and pharmaceuticals and in gas treatment plants |
Manufacturing (cable, glass, paint, petroleum, tire and rubber, textile); service industry (hairdressers, painters, tar and asphalt workers, truck drivers) |
Approximately 90 percent of epithelial bladder tumors are urothelial carcinomas; the remaining 10 percent are nonurothelial or mesenchymal in origin (Table 2).11 The World Health Organization/International Society of Urological Pathology classification of urothelial carcinomas was published in 1998 and favors the use of the term "urothelial" over "transitional" to describe epithelial tumors of the bladder.11 The pathologic classification and histologic grading and staging of bladder tumors are shown in Tables 211 and 3.12
Table 2 Classification of Bladder Cancer
Classification of Bladder Cancer
Epithelial neoplasms | ||
Urothelial (transitional cell) | ||
neoplasms (90 percent) | ||
Papilloma | ||
Flat | ||
Papillary | ||
Papillary urothelial carcinoma | ||
Low malignant potential | ||
Low-grade | ||
High-grade | ||
Invasive urothelial carcinoma | ||
Lamina propria invasion | ||
Muscularis propria (detrusor muscle) invasion | ||
Nonurothelial neoplasms (9 percent) | ||
Squamous cell carcinoma | ||
Verrucous carcinoma | ||
Adenocarcinoma | ||
Clear cell | ||
Hepatoid | ||
Nonurachal | ||
Signet ring cell | ||
Urachal | ||
Small cell carcinoma | ||
Rare neoplasms | ||
Basaloid squamous cell carcinoma | ||
Carcinoid tumor | ||
Lymphoepithelial carcinoma | ||
Melanoma | ||
Nonepithelial (mesenchymal) neoplasms (1 percent) | ||
Benign | ||
Hemangioma | ||
Leiomyoma | ||
Lipoma | ||
Neurofibroma | ||
Paraganglioma | ||
Malignant | ||
Angiosarcoma | ||
Leiomyosarcoma | ||
Malignant fibrous histiocytoma | ||
Osteosarcoma | ||
Rhabdomyosarcoma |
Information from reference 11.
Table 3 American Joint Committee on Cancer TNM Staging System for Bladder Cancer
American Joint Committee on Cancer TNM Staging System for Bladder Cancer
Primary tumor (T) | |||
Primary tumor cannot be assessed | ||
No evidence of primary tumor | ||
Ta: |
Noninvasive papillary carcinoma | ||
Tis: |
Carcinoma in situ ("flat tumor") | ||
Tumor invades subepithelial connective tissue | ||
Tumor invades muscle | ||
pT2a: |
Tumor invades superficial muscle (inner half) | ||
pT2b: |
Tumor invades deep muscle (outer half) | ||
Tumor invades perivesical tissue | ||
pT3a: |
Microscopically | ||
pT3b: |
Macroscopically (extravesical mass) | ||
Tumor invades any of the following: prostate, uterus, vagina, pelvic wall, abdominal wall | ||
T4a: |
Tumor invades prostate, uterus, vagina | ||
T4b: |
Tumor invades pelvic wall, abdominal wall | ||
Regional lymph nodes (N) | |||
Regional lymph nodes are those within the true pelvis; all others are distant lymph nodes | |||
Regional lymph nodes cannot be assessed | ||
No regional lymph node metastasis | ||
Metastasis in a single lymph node, 2 cm or less in greatest dimension | ||
Metastasis in single lymph node, more than 2 cm but not more than 5 cm in greatest dimension; or multiple lymph nodes, none more than 5 cm in greatest dimension | ||
Metastasis in lymph node more than 5 cm in greatest dimension | ||
Distant metastasis (M) | |||
Distant metastasis cannot be assessed | ||
No distant metastasis | ||
Distant metastasis | ||
Stage grouping | |||
0a |
Ta |
0is |
Tis |
T2a |
T2b |
T3a |
T3b |
T4a |
T4b |
Any T |
Any T |
Any T |
Any T |
Any N |
note: Primary tumor assessment includes bimanual examination under anesthesia before and after endoscopic surgery (biopsy or transurethral resection) and histologic verification of the presence or absence of tumor when indicated. Bimanual examination following endoscopic surgery is an indicator of clinical stage. The finding of bladder wall thickening, a mobile mass, or a fixed mass suggest the presence of T3a, T3b, and T4b disease, respectively. Appropriate imaging techniques for lymph node evaluation should be used. When indicated, evaluation for distant metastases includes imaging of the chest, biochemical studies, and isotopic studies to detect common metastatic sites.
Reprinted with permission from Urinary bladder. In: Greene FL, Page DL, Fleming ID, et al., eds. AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer-Verlag; 2002:335-337.
Clinical Presentation
Painless hematuria is the most common presenting symptom.13 Gross blood throughout micturition is suggestive of bladder cancer. The incidence of bladder cancer in a patient with gross hematuria is 20 percent14,15 and with microscopic hematuria is 2 percent.16-18 Symptoms of bladder irritation, such as urinary frequency and urgency, more commonly occur in patients with bladder carcinoma in situ. Obstructive symptoms may be present if the tumor is located near the urethra or bladder neck. In advanced disease, patients may present with flank pain caused by ureteral obstruction, or with abdominal, pelvic, or bone pain from distant metastases (Table 41,13). Early bladder cancer is not detectable by physical examination; however, a mass may be palpable in advanced disease. A palpable kidney or pelvic mass may be present in metastatic disease.
Table 4 Signs and Symptoms of Bladder Cancer
Signs and Symptoms of Bladder Cancer
Hematuria (gross or microscopic) | |
Irritative symptoms | |
Dysuria, frequency, urge incontinence, urgency | |
Obstructive symptoms | |
Decreased force of stream, feeling of incomplete voiding, intermittent stream, straining | |
Signs and symptoms of metastases or advanced disease | |
Abdominal, bone, flank, or pelvic pain; anorexia, cachexia, or pallor; lower extremity edema; renal failure; respiratory symptoms (e.g., cough, dyspnea, hemoptysis); suprapubic palpable mass |
The clinical investigation should begin with a careful history, including any history of cigarette smoking or occupational exposures. Patients with urinary symptoms should have a urinalysis with urine microscopy and a urine culture to rule out infection.
Urine cytology is a noninvasive test for the diagnosis of bladder cancer. It is used to identify high-grade tumors and monitor patients for persistent or recurrent disease following treatment. Urine cytology has a high specificity (95 to 100 percent), but a low sensitivity (66 to 79 percent) for the detection of bladder cancer.19,20 This limits its usefulness for detection of bladder cancer in asymptomatic persons.
Cystoscopy, an office procedure usually performed under local anesthesia, remains the mainstay of diagnosis and surveillance. Patients presenting with symptoms of bladder cancer should be evaluated with cystoscopy to determine if a lesion is present. Cystoscopy provides information about the tumor location, appearance, and size. Detection of flat neoplastic lesions, such as carcinoma in situ, can be enhanced by using fluorescence cystoscopy.18 This involves the use of a photosensitizer, such as 5-aminolevulinic acid or hexaminolevulinic acid, that is instilled intravesically. This induces macroscopic fluorescence of tumor tissue in the bladder. The procedure carries a 5 percent risk of urinary infection.
Bladder wash cytology detects carcinoma in situ in almost all cases, even when the urothelium appears grossly normal, and obviates the need for random bladder biopsies.19,20 Patients with symptoms of bladder cancer should be evaluated with cystoscopy and bladder wash cytology.14
Upon detection of a lesion, a bimanual examination under anesthesia and transurethral resection of the tumor is performed. The muscle surrounding the tumor should be sampled to assess the depth of muscle invasion.
Additional workup for all patients with bladder cancer includes evaluation of the upper urinary tract with intravenous urography (IVU), renal ultrasonography, computed tomography (CT) urography, or magnetic resonance urography.21,22 Renal ultrasonography alone is insufficient to complete the evaluation of hematuria in a patient with bladder cancer because it cannot delineate details of the urinary collecting system. Traditional IVU has been largely replaced by CT urography because of increased detail and data combined in the CT (e.g., extravesical spread of tumor, lymph node evaluation).
For patients unable to undergo contrast injection (e.g., those with allergy, renal insufficiency), magnetic resonance urography may be used to evaluate the upper urinary tract. These tests are useful for disease staging and excluding other causes of hematuria. Pelvic imaging should be performed before transurethral resection to improve staging accuracy because postoperative inflammation mimics the appearance of tumor infiltration.21 Pelvic imaging also may detect synchronous upper tract urothelial cancer, which can occur in 5 percent of patients with bladder cancer.22
Complete blood count, blood chemistry tests (including alkaline phosphatase tests), liver function tests, chest radiography, and CT or magnetic resonance imaging of the abdomen and pelvis should be included in the metastatic workup for invasive bladder cancer.12 A bone scan may be performed if the alkaline phosphatase level is elevated or if symptoms suggesting bone metastasis are present.
In recent years, there has been an intense debate about the role of urine-based tumor markers in the diagnosis and surveillance of bladder cancer. Newer tumor marker tests include the bladder tumor antigen (BTA) stat test and BTA Trak test; fluorescence in situ hybridization (FISH) analysis; ImmunoCyt test; nuclear matrix protein 22 (NMP22) test and NMP22 BladderChek test; and telomeric repeat amplification protocol.16 Tumor marker tests approved by the U.S. Food and Drug Administration, such as NMP tests and FISH analysis for chromosomal changes in cells in urine, have demonstrated a superior sensitivity to urine cytology for low-grade tumors and an equivalent sensitivity for high-grade tumors and carcinoma in situ.23 No tumor markers have the specificity of traditional urine cytology for detection of bladder cancer; therefore, tumor markers should not be used for diagnosis.23
There are no current recommendations for bladder cancer screening. The U.S. Preventive Services Task Force recommends against routine screening for bladder cancer in adults (D recommendation).24 There is no good evidence that the early treatment of this disease improves long-term health outcomes. Urine-based tests, such as urine dipstick to assess for hematuria, urine cytology, and tumor markers (e.g., BTA, NMP22), have been used as screening tools. However, because of the low prevalence of bladder cancer, the positive predictive value of these tests is low.
Optimal treatment is multidisciplinary, involving urology, pathology, and oncology (Tables 525 and 625, and Figure 125 ). Close follow-up is essential with bladder cancer (Table 725,26).
Table 5 Treatment of Nonurothelial Bladder Carcinoma
Treatment of Nonurothelial Bladder Carcinoma
Carcinoma | Treatment |
Squamous cell carcinoma |
Cystectomy or radiation therapy |
Adenocarcinoma |
Cystectomy or partial cystectomy |
Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (Platinol) ineffective; consider fluorouracil-based therapy | |
Small cell carcinoma |
Neoadjuvant or adjuvant chemotherapy using small cell regimen |
Local treatment (surgery or radiation therapy) | |
Mixed histology |
Follow urothelial bladder carcinoma guidelines |
Information from reference 25.
Table 6 Treatment of Urothelial (Transitional Cell) Bladder Carcinoma
Treatment of Urothelial (Transitional Cell) Bladder Carcinoma
Tumor | Treatment |
Low-grade Ta |
Transurethral resection without intravesical chemotherapy |
Some experts suggest a single dose of intravesical chemotherapy (not immunotherapy) within 24 hours of resection to prevent recurrence | |
High-grade Ta |
Repeat transurethral resection (if lymphovascular invasion, incomplete resection, or no muscle in the specimen), consider intravesical BCG (preferred) or mitomycin |
Carcinoma in situ/tumor in situ |
Transurethral resection followed by intravesical BCG once a week for six weeks |
Low-grade T1 |
Repeat transurethral resection followed by intravesical BCG (preferred) or mitomycin |
High-grade T1 |
Repeat transurethral resection, followed by intravesical BCG or mitomycin, or cystectomy |
T2a or T2b (organ confined) |
Radical cystectomy followed by chemotherapy in high-risk patients (e.g., those with nodal involvement, high-grade histology, transmural or vascular invasion, pathologic T3 lesion) |
T3a or T3b |
Radical cystectomy followed by adjuvant chemotherapy, consider neoadjuvant chemotherapy |
Two trials have shown survival benefit with neoadjuvant chemotherapy (three cycles of methotrexate, vinblastine, doxorubicin [Adriamycin], and cisplatin [Platinol]) in T2 or T3 disease | |
T4a, T4b, or metastatic disease |
Chemotherapy alone or in combination with radiation therapy, except in high-risk patients (e.g., those with poor performance status, visceral [lung or liver] disease, bone disease, poor cardiac status) |
Radiation therapy not routinely used in the United States for locally advanced bladder cancer |
BCG = bacille Calmette-Guérin.
Information from reference 25.
Figure 1.
Table 7 Follow-up for Bladder Cancer
Follow-up for Bladder Cancer
Tumor | Follow-up |
Low-grade Ta |
Cystoscopy every three months for one year; increase interval as appropriate |
T1 and high-grade Ta |
Cystoscopy and urine cytology every three months for two years, then every six months for two years, then annually |
Imaging of the upper tract collecting system every one to two years | |
Urinary tumor markers for urothelial cancer optional | |
T2 and above (muscle-invasive disease) |
Liver function test, creatinine clearance test, electrolyte panel, chest radiography every six to 12 months |
Imaging of upper urinary tract, abdomen, and pelvis for recurrence every three to six months for two years, and then as clinically indicated | |
If bladder-sparing surgery, urine cytology with or without biopsy every three months for one year, then increase interval | |
If cystectomy, urine cytology every six to 12 months | |
If cystectomy and cutaneous diversion, urethral wash cytology every six to 12 months | |
If cystectomy and continent orthotopic diversion, monitor vitamin B12 level annually* |
Three stages of bladder cancer (non-muscle-invasive papillary carcinoma [stage Ta], carcinoma in situ [stage Tis], and tumor invading the lamina propria [stage T1]) were previously referred to as superficial bladder cancer, but now are described as non-muscle-invasive bladder cancer. Approximately 70 to 75 percent of bladder cancers present as non-muscle-invasive tumors. These tumors are initially treated by transurethral resection followed by close observation or intravesical chemotherapy or immunotherapy.25
Depth and grade of tumor invasion, completeness of resection, and estimated probability of recurrence are key factors that guide the use of intravesical therapy. Low-grade Ta cancers are treated with resection alone. High-grade Ta and T1 cancers have a higher risk of recurrence and progression to more invasive stages, and therefore may require further resection (repeat transurethral resection of bladder tumor), intravesical bacille Calmette-Guérin (BCG), or mitomycin. Intravesical BCG therapy is preferred over mitomycin for those at high risk of disease progression. Radical cystectomy should be considered for high-risk, non-muscle-invasive bladder cancers, such as recurrent high-grade T1 disease or tumors with micropapillary histology.27 Bladder carcinoma in situ is believed to be a precursor of invasive disease. Transurethral resection followed by intravesical BCG once per week for six weeks is recommended for carcinoma in situ.
Radical cystectomy with pelvic lymphadenectomy is the standard treatment for muscle-invasive bladder cancer (stage T2 and above).28 Long-term, disease-free survival rates of up to 70 percent can be achieved if pathology shows no extravesical diseases.28 Radical cystectomy involves cystoprostatectomy in men and cystectomy (usually with hysterectomy) in women, followed by a urinary diversion procedure. Segmental cystectomy may be considered for solitary lesions without carcinoma in situ located in suitable locations. In patients with extensive comorbid disease, bladder preservation strategies (transurethral resection with or without chemotherapy) are sometimes used instead of cystectomy to limit treatment-associated morbidity.
Neoadjuvant and adjuvant chemotherapy has been explored in patients with muscle-invasive disease and is best reserved for high-risk patients (e.g., those with nodal involvement, high-grade histology, transmural or vascular invasion, pathologic T3 lesion). Combination gemcitabine (Gemzar) and cisplatin (Platinol) is the standard treatment for most patients because of its lower toxicity. Combination methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) has comparable effectiveness to gemcitabine/cisplatin; however, toxicity limits its use.29 Chemotherapy is not used for nonurothelial cancers, such as squamous cell carcinoma or adenocarcinoma, which are primarily treated with cystectomy.
Patients with metastatic disease are treated with chemotherapy. The specific chemotherapy regimen depends on existence of medical comorbidities, such as cardiac and renal dysfunction. A commonly used combination is cisplatin and gemcitabine or a multidrug cisplatin-based regimen, such as MVAC. Carboplatin-based regimens are used in patients with insufficient renal reserve. If muscle invasion has occurred, radical cystectomy with pelvic lymphadenectomy remains the treatment of choice. Lifestyle modifications, including smoking cessation, are an integral part of treatment. Upon diagnosis, patients require continuous surveillance (Table 7 25,26) because most recurrences can be successfully treated if detected early.
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