Bladder cancer is one of the most common cancers in both men and women and the median age of diagnosis is sixty five years. About fifty percent of cases are related to cigarette smoking duration. In the United States, bladder cancer is the fourth most common cancer in men and the ninth most common cancer in women.
Over 80 percent of renal cancers occur in the bladder. Because of the prolonged latency between the exposure to carcinogens ( such as cigarette smoke) and the development of the clinical disease, makes it a bit difficult to establish a causative link. Smoking accounts for about 50 percent of cases in men and about 25 percent are related to occupational exposure.
People who work at aluminum manufacturing companies and those who work as chimney sweeps and drycleaners also have higher risk of developing bladder carcinoma. Some believe that a higher consumption of fried meats and fat also plays a role in the development of the tumor. Some drug therapy such as cylophosphamide and infestations such as schistosomiasis also potentiates the development of the cancer.
The bladder is lined principally with transitional epithelium, therefore the commonest form of bladder cancer is transitional cell carcinoma accounting for about 90 to 95 percent of cases, followed by squamous cell carcinoma (3 percent) and then adenocarninoma making up bout 2 percent.
Symptoms, Signs and Diagnosis Of Bladder Cancer
In a majority of bladder cancer cases, the first sign is usually hematuria (blood in the urine), followed by increased frequency of urination or irritative symptoms. Other possible symptoms include flank pain or discomfort, pain during urination. Symptoms of distance spread of the disease may also occur. The bladder accounts for most cases of frank blood in the urine. Screening of asymptomatic subjects for blood in the urine increases the likelihood of early detection of bladder carcinoma.
Evaluation Of Bladder Carcinoma
The evaluation of bloody urine or suspected bladder carcinoma requires cytological examination of the urine, ultrasound visualization of the urinary tract, intravenous pyelogram( injection of a radiocontrast agent into the urinary system and regular X-ray imaging) and cystoscopy (inserting a small thin camera into the urethra and using it to view the interior of the bladder).
CT scans has largely replaced intravenous pyelogram as a preferred diagnostic method, because it is more sensitive and therefore detects smaller abnormalities that would otherwise be missed. Computer tomography and magnetic resonance imaging may assist in detecting tumors that have spread to local and distant organs. Based on the investigations and clinical presentation, the tumor is classified into stages accordingly.
Histologic staging of the disease provides information about the prognosis of the disease, for example grade I lesions rarely progress to a higher stage while grade III tumor carries a higher risk of disease progression. The risk of recurrent disease is directly related to the size of the tumor, number of lesions, growth pattern, presence of local or distance metastasis and the present of hydronephrosis (swelling of a kidney due to a back-up of urine).
Genetic analysis has shown that certain chromosomal abnormalities impact the development and progression of the tumor, but we’ll leave the detail of such discussion here.
Management of Bladder Carcinoma
The choice of the treatment modality is dependent on whether the tumor is superficial, invasive or metastatic. Superficial tumors are often treated with endoscopic removal with or without intra-bladder therapy. Once it has been esterblished that the disease is invasive, the standard treatment is surgical resection of the bladder, with or without systemic chemotherapy ( depending on the pathological findings at surgery). Your doctor would determine the most appropriate treatment modality for the disease.
Related Resource: https://www.cancer.gov/types/bladder