Bladder cancer

Bladder cancer

Ninety-five percent of all malignant diseases of the urinary tract originate from the urothelium (2).

The urinary tract lined with urothelium (transitional cells) includes calyses, renal pelvis, ureters, urinary bladder and upper urethra.

Urothelial cancer occurs most frequently in the bladder. Primary urothelial cancer in the urethra is rare. Urothelial cancer in the urethra is often secondary to cancer originating in the bladder, which grows down into the urothelium in the upper part of the urethra. 

Urothelial cancer is often multifocal and the disease is considered a general disease of all the urothelium. It is a heterogenous disease that varies in aggressiveness, which plays a significant role for the choice of treatment and follow-up care. The disease is easy to diagnose when localized to the bladder, and has a high cure rate, but also a high rate of recurrence.

Usually, urothelial cancer arises from a malignant transformation of cells in an apparently normal-looking urothelium (carcinoma in situ). Depending on the malignancy potential of these primary cells, they can form papillomatous tumors that do not infiltrate for a long time. 



Papillomatous tumors do not usually cause early symptoms of hematuria. Tumors that grow solid and nodular usually begin to infiltrate from an early stage. Flat infiltrating carcinoma in situ is a tumor type that does not necessarily appear like a tumor, but can metastasize without the patient having noticeable hematuria.   

Incidence

In Norway in 2013, there were 1544 reported new cases of cancer of the bladder, ureter, urethra and renal pelvis.

The incidence of urothelial cancer has been increasing over the years. Urothelial cancer rarely occurs in people under 50 years, and affects more men than women (3:1).

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