Bladder Cancer
Basics
A primary cancer tumor originating in cells lining the urinary bladder lumen
Description
- Bladder cancer (BC) cell types: urothelial carcinoma (formerly named transitional cell) and others (squamous cell and adenocarcinoma)
- Urothelial carcinoma comprises >90% of all cases in the USA and Europe.
- The spectrum BC relates to tumor penetration into muscularis propria layer or not:
- Nonmuscle invasion (NMIBC)
- Muscle invasion (MIBC)
- Metastatic disease (MIBC plus spread beyond the bladder)
- Very rarely, uroepithelial carcinoma or rhabdomyosarcoma of the bladder in children
Epidemiology
Primarily white men aged >55 years who smoke tobacco
Incidence
- Estimated 4.2% of all new cancer cases in 2023
- Increases with age (median age at diagnosis is 73 years)
- Two times more common in Whites than in other races
- Incidence rate in Asia is predicted to rise 74% from 2020 to 2024, compared to 52% in North America.
- Male > female (3 to 4:1); but in smokers, risk is 1:1.
- Fourth most common cancer in men and the eighth most common cause of cancer death in United States
- Lifetime risk: 1 in 28 for men, 1 in 91 for women
- Women are diagnosed in more advanced stages than men (hematuria mimicking gynecologic illnesses).
- Decreased incidence rate primarily in men in 2004–2020
- 15.8/100,000 new cases age-adjusted rate for all in 2020, the United States
Prevalence
- Lifetime risk is 2.3% overall based on 2017–2020 data in United States.
- In 2020, 725,549 cases in the United States, far exceeding the population of Wyoming or Vermont.
Etiology and Pathophysiology
Unknown, other than related to risk factors
- 70% is nonmuscle invasive, longer survival.
- 30% of tumors are muscle invasive at presentation, prognosis worse.
Genetics
- Same-sex, monozygotic twins have 10% increase risk.
- Patient with Lynch syndrome has up to 20% lifetime risk due to altered DNA mismatch repair genes.
Risk Factors
- Male sex
- Advanced age, greatest single risk factor, due to prolonged exposure time to risky substances
- Tobacco smoking is the single greatest modifiable risk factor.
- 50% cases attributed to personal smoking.
- Secondhand tobacco smoke exposure or e-cigarettes contain carcinogenic compounds.
- Other risk factors:
- Occupational exposures to benzidine; magenta, auramine dyes; aluminum and rubber production; certain paints, plastics, carbon black dust (printing ink), petroleum, and diesel exhaust; and soot from chimneys
- Arsenic 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/hpf) 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/hpf) 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 smoke exposure.
- https://www.cdc.gov/tobacco/quit_smoking/index.htm or 800-QUIT NOW (800-784-7669)
- Counseling of avoidance in individuals with risky occupational exposure
- Prompt follow-up for individuals with hematuria, regardless of anticoagulation or antiplatelet status
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Citation
Domino, Frank J., et al., editors. "Bladder Cancer." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688743/all/Bladder_Cancer.
Bladder Cancer. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688743/all/Bladder_Cancer. Accessed August 31, 2024.
Bladder Cancer. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688743/all/Bladder_Cancer
Bladder Cancer [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2024 August 31]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688743/all/Bladder_Cancer.
* Article titles in AMA citation format should be in sentence-case
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