Bladder cancer

Incidence and mortality

In 2011, 2404 new cases of bladder cancer were diagnosed in Australia. It is significantly more common in men - the risk of bladder cancer by age 85 is 1 in 43 for men, compared to 1 in 166 for women.

In 2012, there were 1038 deaths caused by bladder cancer in Australia.

Screening

No screening test is routinely used for bladder cancer.

Symptoms and diagnosis

The most common symptom of bladder cancer is blood in the urine (haematuria), which usually occurs suddenly and is generally not painful

:Other less common symptoms include

problems emptying the bladder

a burning feeling when passing urine

need to pass urine often.

:Tests used to diagnose bladder cancer include

urine test

blood test

intravenous pyelogram

liver and abdominal ultrasound scan

cytoscopy and biopsy.

Staging

A CT scan, bone (radioisotope) scan and chest x-ray are done to determine the extent of the cancer (its stage).

The most common staging system used for bladder cancer is the TNM system, which describes the stage of the cancer from stage I to stage IV.

Causes

The exact causes of bladder cancer are not known, however factors that put some people at higher risk are:

smoking cigarettes

workplace exposure to certain chemicals used in dyeing in the textile, petrochemical and rubber industries

use of the chemotherapy drug cyclophosphamide (which can increase the long-term risk of bladder cancer).

Chronic inflammation of the bladder has been linked to squamous cell carcinoma of the bladder.

Prevention

Not smoking or quitting smoking, and avoiding exposure to chemicals listed above

Treatment

Superficial bladder cancers are treated with surgery (transurethral resection) and/or immunotherapy, or sometimes chemotherapy instilled into the bladder

Invasive bladder cancers are most commonly treated with surgery, although radiotherapy is an alternative treatment. In some cases chemotherapy may be added

If surgery is not an option, the cancer may be treated with radiotherapy, with or without chemotherapy, or chemotherapy alone (platinum and gemcitabine)

Prognosis

An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis

Bladder cancer can be effectively treated if it is found early, before it spreads outside the bladder. The five year survival rate for Australians with bladder cancer is 58%

For more information, contact Cancer Council 13 11 20 (cost of a local call)

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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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