Bladder Cancer

Leave a Comment / Oncology / By

Bladder Cancer

Bladder cancer is a malignancy of the urinary bladder, most commonly arising from the urothelium (the inner lining). It is the 10th most common cancer worldwide, with a higher prevalence in older males.

🧬 Types of Bladder Cancer

TypeFrequencyNotes
Urothelial carcinoma~90%Formerly called transitional cell carcinoma; arises from bladder lining
Squamous cell carcinoma~5%Often linked to chronic irritation (e.g., schistosomiasis)
Adenocarcinoma~1–2%Rare; may arise from urachal remnant or glandular metaplasia
Small cell carcinoma<1%Very aggressive, neuroendocrine type

⚠️ Risk Factors

  • Smoking (most significant modifiable risk)
  • Chemical exposure (aromatic amines, dyes, rubber industry)
  • Chronic bladder irritation (e.g., catheters, stones, infections)
  • Schistosoma haematobium infection (Africa/Middle East – ↑ squamous cell type)
  • Age > 55, male sex, family history
  • Cyclophosphamide or pelvic radiation

🩺 Symptoms

  • Painless gross hematuria (most common presenting symptom)
  • Irritative voiding symptoms: frequency, urgency, dysuria
  • Pelvic pain (in advanced cases)
  • Weight loss, flank pain (if locally advanced or metastatic)

🧪 Diagnosis

  1. Urinalysis & Urine Cytology
    • Microscopic or gross hematuria
    • Cytology can detect high-grade or carcinoma in situ
  2. Cystoscopy
    • Gold standard for diagnosis and surveillance
    • Allows direct visualization and biopsy
  3. Imaging
    • CT Urogram or MRI: assess upper tract and bladder wall
    • Chest/abdomen/pelvis CT: staging
  4. TURBT (Transurethral Resection of Bladder Tumor)
    • Both diagnostic and therapeutic for non-muscle invasive tumors

🏥 Staging (TNM System)

StageDescription
TaNon-invasive papillary tumor
T1Invades lamina propria
T2Invades muscularis propria
T3Invades perivesical fat
T4Invades adjacent organs (e.g., prostate, uterus, pelvic wall)
NRegional lymph node involvement
MDistant metastasis

💊 Treatment Overview

🔹 Non–Muscle-Invasive Bladder Cancer (NMIBC) (Ta, T1, CIS)

  • TURBT followed by intravesical therapy:
    • BCG (for CIS or high-grade tumors)
    • Mitomycin C (for low-grade recurrence)
  • Regular surveillance with cystoscopy and cytology

🔹 Muscle-Invasive Bladder Cancer (MIBC) (≥ T2)

  • Radical cystectomy with urinary diversion
  • Neoadjuvant chemotherapy (cisplatin-based) improves survival
  • Bladder preservation approach (selected patients): TURBT + chemoradiation

🔹 Metastatic or Advanced Disease

  • Systemic chemotherapy (cisplatin + gemcitabine)
  • Immunotherapy (e.g., checkpoint inhibitors: atezolizumab, pembrolizumab)
  • Targeted therapy in select cases

🔁 Surveillance

  • Lifelong, especially for NMIBC due to high recurrence risk
  • Routine:
    • Cystoscopy (every 3–6 months initially)
    • Urine cytology
    • Periodic imaging (for upper tract and metastatic monitoring)

📈 Prognosis

Stage5-Year Survival Rate
Non–muscle-invasive (Ta, T1, CIS)~80–90%
Muscle-invasive (T2–T3)~50–60%
Locally advanced/metastatic<20%

Call Now Button