Bladder cancer

Definition

• Bladder cancer: A malignant tumour arising from the cells lining the urinary bladder.

Etiology & Risk Factors

• Smoking: Significantly increases risk.
• Exposure to industrial chemicals: Aromatic amines (benzidine and beta-naphthylamine).
• Chronic bladder inflammation: Repeated urinary infections or long-term catheter use.
• Radiation exposure.
• Family history of bladder cancer.
• Age: Most common in older adults.

Types

• Transitional cell (urothelial) carcinoma: Most common type.
• Squamous cell carcinoma.
• Adenocarcinoma.

Clinical Presentation

• Painless haematuria: Most common symptom.
• Frequent urination or urgency to urinate.
• Dysuria (painful urination).
• Back or pelvic pain.

Investigations

• Cystoscopy: Direct visualisation of the bladder lining.
• Urine cytology: Microscopic examination of urine for cancer cells.
• Imaging: CT urogram or MRI.
• Biopsy during cystoscopy.

Staging

• Staging is crucial for determining treatment approach and prognosis.
• Based on TNM system: Tumour size, lymph Node involvement, and Metastasis.

Management

• Transurethral resection: For early-stage tumours.
• Chemotherapy: Intravesical (directly into the bladder) or systemic.
• Radiotherapy: An option for some individuals.
• Cystectomy: Removal of part (partial) or all (radical) of the bladder.
• Immunotherapy: BCG vaccine directly into the bladder to stimulate an immune response.

Complications

• Recurrence of the cancer.
• Chronic urinary issues post-treatment.
• Side effects of treatments, e.g., bladder irritation from intravesical chemotherapy.

Prognosis

• Depends on stage, grade, and type of bladder cancer.
• Regular follow-up with cystoscopies is required due to a high risk of recurrence.