Bladder Cancer

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Basics

Description

  • Primary malignant neoplasms arising in the urinary bladder
  • Most common type is transitional cell carcinoma (90%).
  • Other types include adenocarcinoma, small cell carcinoma, and squamous cell carcinoma.
  • Rhabdomyosarcoma of the bladder may occur in children.

Epidemiology

Incidence
  • Increases with age (median age at diagnosis is 73 years) (1)
  • More common in Caucasians than in Asians or African Americans
  • Male > female (4:1); but in smokers, risk is 1:1.
  • 34.3/100,000 men per year (1)
  • 8.3/100,000 women per year (1)
  • 19.5/100,000 men and women per year (1)

Prevalence
In 2015, 708,444 cases in the United States (1)

Etiology and Pathophysiology

Unknown, other than related to risk factors:

  • 70–80% is nonmuscle invasive (in lamina propria or mucosa):
    • Usually highly differentiated with long survival
    • Initial event seems to be the activation of an oncogene on chromosome 9 in superficial cancers.
  • 20% of tumors are muscle invasive (deeper than lamina propria) at presentation:
    • Tend to be high grade with worse prognosis
    • Associated with other chromosome deletions

Genetics
Hereditary transmission is unlikely, although transitional cell carcinoma pathophysiology is related to oncogenes. The GSTM1-null genotype may be associated with increased risk.

Risk Factors

  • Smoking is the single greatest risk factor (increases risk 4-fold) and increases risk equally for men and women (2).
  • Use of pioglitazone for >1 year may be associated with an increased risk of bladder cancer. The risk seems to increase with duration of therapy and may also be present with other thiazolidinediones.
  • Other risk factors:
    • Occupational carcinogens in dye, rubber, paint, plastics, metal, carbon black dust, and automotive exhaust
    • Schistosomiasis in Mediterranean (squamous cell) cancer
    • Arsenic in well water
    • History of pelvic irradiation
    • Chronic lower UTI
    • Chronic indwelling urinary catheter
    • Cyclophosphamide exposure
    • High-fat diet
    • Coffee consumption associated with reduced risk (RR 0.83; 95% CI 0.73–0.94)

ALERT
Any patient who smokes and presents with microscopic or gross hematuria or irritative voiding symptoms such as urgency and frequency not clearly due to UTI should be evaluated by cystoscopy for the presence of a bladder neoplasm.

General Prevention

  • Avoid smoking and other risk factors.
  • Counseling of individuals with occupational exposure
  • The U.S. Preventive Services Task Force has concluded that there is insufficient evidence to determine the balance between risk and harm of screening for bladder cancer (3).

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