Bladder Cancer

 

Bladder Cancer is cancer of the tissues of the urinary bladder. Bladder cancer begins most often in epithelial lining.  Bladder cancer typically affects older adults, though it can occur at any age. Bladder cancers usually presents with hematuria, frequent urination, painful urination, urinary tract infection, and abdominal and low back pain. The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. Most common histological type of bladder cancer is transitional cell carcinoma (urothelial carcinoma). Other types are squamous cell carcinoma and adenocarcinoma. Some bladder cancers include more than one type of cell. Squamous cells appear in your bladder in response to infection (schistosomiasis) and irritation (stones). Adenocarcinoma begins in mucus-secreting glands in the bladder (exstrophic bladder). In the United States, urothelial carcinomas account for more than 90% of all bladder cancers. Squamous cell carcinomas make up 3%-8%, and adenocarcinomas make up 1%-2%. Of all types of cancer, bladder cancer has an unusually high propensity for recurring after treatment. Bladder cancer has a recurrence rate of 50%-80%. The recurring cancer is usually, but not always, of the same type as the first (primary) cancer. It may be in the bladder or in another part of the urinary tract (kidneys or ureters). Primary bladder lymphomas arise in the submucosa of the bladder and are treated with radiation therapy. Leiomyosarcoma is the most common sarcoma of the bladder. Rhabdomyosarcomas most commonly occur in children and carry a poor prognosis. Bladder cancer is the fourth most common cancer in men in the United States, after prostate, lung, and colorectal cancer. Bladder cancer is the 10th most common cancer in women.A number of factors may increase your risk of bladder cancer, including: smoking, chemical exposure, chemotherapy (cyclophosphamide and ifosfamide), radiation therapy, chronic bladder inflammation, family history of cancer, birth defect and artificial sweeteners (in animals). Nitrosamine, 2-naphthylamine, and 4-aminobiphenyl are possible carcinogenic agents found in cigarette smoke. Bladder cancer is also associated with industrial exposure to aromatic amines in dyes, paints, solvents, leather dust, inks, combustion products, rubber, and textiles. Therefore, higher-risk occupations associated with bladder cancer include painting, driving trucks, and working with metal. Bladder cancer is more common in whites than in blacks; however, blacks have a worse prognosis than whites. The male-to-female ratio is 3:1. Women generally have a worse prognosis than men. The median age at diagnosis is 68 years, and the incidence increases with age.   The World Health Organization classifies bladder cancers as low grade (grade 1 and 2) or high grade (grade 3). Tumors are also classified by growth patterns: papillary (70%), sessile or mixed (20%), and nodular (10%). Carcinoma in situ (CIS) is a flat, noninvasive, high-grade urothelial carcinoma. The most significant prognostic factors for bladder cancer are grade, depth of invasion, and the presence of CIS. The stages of bladder cancer are: § Stage I. Cancer at this stage occurs in the bladder's inner lining, but hasn't invaded the muscular bladder wall. § Stage II. At this stage, cancer has invaded the bladder wall. § Stage III. The cancer cells have spread through the bladder wall to surrounding tissue. They may also have spread to the prostate in men or the uterus or vagina in women. § Stage IV. By this stage, cancer cells may have spread to the lymph nodes and other organs, such as your lungs, bones or liver. Treatment options for bladder cancer depend on a number of factors, including the type and stage of the cancer. Surgical options include transurethral resection of bladder tumor (TURBT), partial cystectomy, and total cystectomy. Immunotherapy is typically administered through your urethra and directly into the bladder (intravesical therapy). It includes administration of Bacille Calmette-Guerin (BCG) and interferons. Chemotherapy can also be given combined with radiation therapy. Radiation options include external beam radiation or brachytherapy.