Bladder Cancer

Bladder cancer is the most common neoplasm of the upper urinary tract and the 7th most common cancer worldwide. It is most often diagnosed in males over 60 years old. Urothelial cell carcinoma is the most common form of bladder cancer (formerly called transitional cell carcinoma), which accounts for approximately 90% of all bladder cancers. Urothelial cell carcinomas make up most bladder cancer types (in the U.S.) This form of cancer can affect any of the structures lined by urothelial cells: the urethra, bladder, ureters, and renal pelvis. The mucosal layer lines these structures and comprises transitional cells and lamina propria; carcinoma originates in the transitional cells. Lesions can be papillary or flat, and start out in the mucosa, but can invade deeper tissues. Key risk factors include smoking, exposure to paint, petroleum, and certain dyes; urothelial cell carcinoma is also associated with Lynch syndrome (aka hereditary nonpolyposis colorectal cancer). Hematuria (gross or microscopic), dysuria, and burning while urinating. We also need to watch for urinary tract obstructions that can lead to hydronephrosis and infection. Patients in advanced stages may experience lower abdominal/pelvic/perineal pain. Unfortunately, bladder cancer commonly reoccurs. We need to watch for metastasis, particularly to the lymph nodes, lungs, liver, and bone. We can use cystoscopy and biopsy to diagnose bladder cancer; imaging may show masses. Read more about bladder cancer stages.. Urinary analysis: hematuria, possible pyuria. Azotemia may be seen in patients with ureteral obstruction. Cytology is most sensitive in higher grade and stage cancers; less so in non-invasive and well-differentiated cases.

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Depend on how invasive the cancer is: If there is no muscularis invasion, we can use endoscopic resection intravesical therapy. If the muscularis has been invaded, we need to perform cystectomy, possibly with chemotherapy. Squamous cell bladder carcinoma is less common than urothelial cell cancer; in these patients, chronic bladder irritation or infection triggers transitional cell transformation to squamous cells. A key risk factor is infection with schistosomiasis.