Bladder Cancer
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.
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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