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- Primary malignant neoplasms arising in the urinary bladder
- Most common type is transitional cell carcinoma (90%)
- Other types include adenocarcinoma, small cell carcinoma, squamous cell carcinoma.
- Rhabdomyosarcoma of the bladder may occur in children.
- Increases with age (median age at diagnosis is 73 years)
- More common in Caucasians than in Asians or African Americans
- Male > Female (4:1), but in smokers, risk is 1:1
- 37.0/100,000 men per year (1)
- 8.9/100,000 women per year (1)
- 20.8/100,000 men and women per year (1)
As of January 1, 2009, 554,347 cases in the US (1)
- Smoking is the single greatest risk factor (increases risk 4-fold), and increases risk equally for men and women (2).
- Other risk factors:
- Occupational carcinogens in dye, rubber, paint, plastics, metal, 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
- Chronic low fluid intake
- Slight increase in risk with prostate cancer
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.
Hereditary transmission is unlikely, although transitional cell carcinoma pathophysiology is related to oncogenes.
- Avoid smoking and other risk factors.
- The US Preventive Services Task Force has concluded there is insufficient evidence to determine the balance between risk and harm of screening for bladder cancer.
- 70–80% is superficial (in lamina propria or mucosa):
- Usually highly differentiated with long survival
- Initial event seems to be activation of an oncogene on chromosome 9 in superficial cancers.
- 20% of tumors are invasive (deeper than lamina propria) at presentation:
- Tend to be high grade with worse prognosis
- Associated with other chromosome deletions
Unknown, other than related to risk factors