Bladder cancer is any of several types of malignancy arising from the epithelial lining (i.e., the urothelium) of the urinary bladder. Rarely the bladder is involved by non-epithelial cancers, such as lymphoma or sarcoma, but these are not ordinarily included in the colloquial term “bladder cancer.”

It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis.

The most common type of bladder cancer recapitulates the normal histology of the urothelium and is known as transitional cell carcinoma or more properly urothelial cell carcinoma. It is estimated that there are 383,000 cases of bladder cancer worldwide.

Bladder cancer characteristically causes blood (redness) in the urine. This blood in the urine may be visible to the naked eye (gross/macroscopic hematuria) or detectable only by microscope (microscopic hematuria). Hematuria is the most common symptom in bladder cancer.

Other possible symptoms include pain during urination, frequent urination, or feeling the need to urinate without being able to do so.

These signs and symptoms are not specific to bladder cancer and are also caused by non-cancerous conditions, including prostate infections, overactive bladder, and cystitis.

There are many other causes of haematuria, such as the bladder or ureteric stones, infection, kidney disease, kidney cancers, and vascular malformations.

Causes

Tobacco smoking is the main known contributor to urinary bladder cancer; in most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women.

There is a linear relationship between smoking and risk, and quitting smoking reduces the risk.

Occupations at risk are bus drivers, rubber workers, motor mechanics, leather (including shoe) workers, blacksmiths, machine setters, and mechanics.

Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes.

Many patients with a history, signs, and symptoms suspicious for bladder cancer are referred to a urologist or other physician trained in cystoscopy.

Cystoscopy is a procedure in which a flexible tube bearing a camera and various instruments is introduced into the bladder through the urethra. Suspicious lesions may be biopsied and sent for pathologic analysis.

The gold standard for diagnosing bladder cancer is biopsy obtained during cystoscopy. Sometimes it is an incidental finding during cystoscopy.

Urine cytology can be obtained in voided urine or at the time of cystoscopy (“bladder washing”).

The treatment of bladder cancer depends on how deep the tumor invades into the bladder wall. Superficial tumors (those not entering the muscle layer) can be “shaved off” using an electrocautery device attached to a cystoscope, which in that case is called a resectoscope.

The procedure is called transurethral resection (TUR) and serves primarily for pathological staging. In the case of non-muscle invasive bladder cancer, the TUR is in itself the treatment, but in the case of muscle-invasive cancer, the procedure is insufficient for final treatment.



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