Bladder Cancer

Descriptive text is not available for this image 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%

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 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 10th most common cause of cancer death in United States
    • Women are diagnosed in more advanced stages than men (hematuria mimicking gynecologic illnesses).
  • 17.4/100,000 new US cases age-adjusted rate for 2021

Prevalence

In 2022, there were 744,039 cases in the United States; far exceeding 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
  • Advanced age, primary risk factor, due to chronic exposure to risky substances
  • Tobacco smoking is the key modifiable risk factor; 50% attribution
  • 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 chimney soot
    • 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 anti-coagulation 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 nonmalignant 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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