Bladder cancer

Question 1

Define

Answer 1

• Malignancy of bladder cells
o Most bladder cancers are transitional cell carcinomas (urothelial carcinoma)
o RARELY, bladder cancers may be squamous cell carcinomas associated with chronic inflammation (e.g. schistosomiasis)

Question 2

What are the risk factors?

Answer 2

o	Smoking (MOST COMMON)
o	Second hand smoke
o	Dye stuffs (naphthylamines and benzidine)
o	Occupational exposure to chemical carcinogens, such as aromatic amines used in rubber and dye industries, and polycyclic aromatic hydrocarbons used in the aluminium, coal, and roofing industries; and exposure to arsenic in drinking water
o	Cyclophosphamide treatment 
o	Pelvic irradiation 
o	Chronic UTIs 
o	Chronic inflammation 
o	Schistosomiasis

Question 3

Epidemiology

Answer 3

• 2% of cancers
• Ranks 9th in worldwide cancer incidence, the incidence of bladder cancer varies significantly, with Egypt, Western Europe, and North America having the highest incidence rates and Asian countries the lowest rates.
• 2nd most common cancer of the genitourinary tract
• 2-3 x more common in MALES
• Peak incidence: 50-70 yrs

Question 4

What are the presenting symptoms?

Answer 4

•	Painless macroscopic/ microscopic haematuria  (Haematuria is the primary presenting symptom of bladder cancer and is present in ≥80% of patients)
•	Irritative/storage symptoms
o	Frequency
o	Dysuria
o	Nocturia
•	Recurrent UTIs 
•	Rarely: ureteral obstruction

Most important, episodes of haematuria are typically intermittent and therefore resolution should not be attributed to treatment with, for example, antibiotics.

Question 5

What are the signs?

Answer 5

• Often NO SIGNS

* Bimanual examination may be performed as part of disease staging

Question 6

What are the investigations?

Answer 6

• Cystoscopy - allows visualisation, biopsy or removal
• Urinalysis - haematuria
• Ultrasound
• Intravenous urography
• CT/MRI for staging