Bladder Cancer
BASICS
A primary cancer tumor originating in cells lining the urinary bladder lumen
DESCRIPTION
- Bladder cancer (BC) cell types: urothelial carcinoma, 90%, (formerly named transitional cell) and others (squamous cell and adenocarcinoma)
- The spectrum of BC relates to tumor penetration into muscularis propria layer or not:
- Nonmuscle invasion (NMIBC); 70% occurrence
- Muscle invasion (MIBC); 25%
- Metastatic disease (MIBC plus spread beyond the bladder); 5%
- Very rarely, uroepithelial carcinoma or rhabdomyosarcoma of the bladder may occur in children
EPIDEMIOLOGY
Primarily white men aged >55 years who smoke tobacco
Incidence
- Estimated 4.2% of all new cancer cases; 83,190 new cases, and 16,840 deaths in the United States for 2024
- Median age at diagnosis is 73 years
- Two times more common in Whites
- Male > female (3 to 4:1); but in smokers, risk is 1:1.
- Fourth most common solid cancer in men and the eighth most common cause of cancer death in USA
- Lifetime risk: 1 in 28 for men, 1 in 89 for women
- Women are diagnosed in more advanced stages than men (hematuria mimicking gynecologic illnesses).
- 15.8/100,000 new cases age-adjusted rate for all in 2020, in the United States
Prevalence
In 2020, there were 725,549 cases in the United States, far exceeding the population of Wyoming or Vermont.
ETIOLOGY AND PATHOPHYSIOLOGY
Related but distinct in genetic alterations related to risk factors
- NMIBC, frequent chromosome 9 deletion and activation of RAS-MAPK pathway
- MIBC, dysfunction of tumor suppressors
Genetics
- Same-sex, monozygotic twins have 10% increased BC risk.
- Patient with Lynch syndrome has up to 20% lifetime BC risk due to altered DNA mismatch repair genes.
RISK FACTORS
- Male sex
- Advanced age, primary risk factor, due to chronic exposure to risky substances
- Tobacco smoking is the single greatest modifiable risk factor.
- 50% cases attributed to personal smoking.
- Smokeless tobacco, secondhand tobacco smoke exposure or e-cigarettes
- Other risk factors:
- Occupational exposures to benzidine; magenta, auramine dyes; aluminum and rubber production; certain paints, plastics, carbon black dust (printing ink), petroleum, diesel exhaust, and soot from chimneys
- Arsenic or pesticide exposure in drinking water
- History of bladder radiation, pelvic irradiation, or certain chemotherapy drugs like cyclophosphamide or ifosfamide
- Chronic lower UTI or chronic indwelling urinary catheter
- Pioglitazone (diabetes), aristolochic acid (herbal supplement), cyclophosphamide, and chlornaphazine
ALERT
Microscopic (≥3 RBC/high power field) or gross hematuria found in a smoker needs cystoscopy and axial upper tract imaging, regardless of anticoagulation or antiplatelet status, unless there is a documented UTI with urgency and frequency that responds to UTI treatment or if related to a gynecologic or other non-malignant genitourinary cause.
Microscopic (≥3 RBC/high power field) or gross hematuria found in a smoker needs cystoscopy and axial upper tract imaging, regardless of anticoagulation or antiplatelet status, unless there is a documented UTI with urgency and frequency that responds to UTI treatment or if related to a gynecologic or other non-malignant genitourinary cause.
GENERAL PREVENTION
- Avoid tobacco exposure.
- https://www.cdc.gov/tobacco/quit_smoking/index.htm or 800-QUIT NOW (800-784-7669)
- Counseling of avoidance if risky occupational exposure
- Prompt follow-up for individuals with any hematuria, regardless of anticoagulation or anti-platelet status
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