Highlights
- Early detection of bladder cancer greatly influences prognosis and treatment effectiveness.
- Smoking significantly increases bladder cancer risk, highlighting the importance of tobacco cessation.
Overview and Symptoms
Bladder cancer originates in the bladder lining and is common worldwide, especially in older adults and men. Key symptoms include blood in the urine (hematuria), changes in urination, and pelvic discomfort. Early detection is crucial as prognosis depends on cancer stage and grade. Diagnosis involves urine cytology, cystoscopy, biopsy, and imaging.
Hematuria is the most common symptom, visible or microscopic, but can also result from benign conditions. Other symptoms include frequent or painful urination and urgency. In women, pelvic exams help rule out other causes. Urinary cytology supports diagnosis but has limited sensitivity for low-grade tumors. Imaging like CT urograms assesses tumor extent.
Risk Factors
Bladder cancer risk factors include modifiable elements like tobacco use and occupational chemical exposures, as well as non-modifiable factors such as age and genetics.
Occupational exposure to aromatic amines in industries like chemical, dye, rubber, and textiles significantly increases risk. Tobacco smoking is the leading risk factor, raising cancer risk about fourfold in current smokers. Arsenic exposure through drinking water and environmental chemicals like trihalomethanes and hair dye components also contribute. Genetic variants influence susceptibility and response to carcinogens.
Diagnosis and Staging
Diagnosis combines urine tests, cystoscopy, biopsy, and imaging. Urine cytology detects cancer cells but is less sensitive for low-grade tumors. Cystoscopy allows direct visualization and biopsy of suspicious lesions, with enhanced techniques improving detection. TURBT is used to remove and sample tumors for histological grading and staging.
Imaging such as CT urograms evaluates tumor size, location, and spread. Staging ranges from non-invasive to advanced metastatic disease, guiding treatment decisions.
Treatment
Treatment depends on cancer stage and patient factors and includes surgery, intravesical therapy, chemotherapy, radiation, and immunotherapy.
TURBT is standard for non-muscle-invasive bladder cancer, often followed by intravesical therapies like BCG to reduce recurrence. Muscle-invasive disease may require partial or radical cystectomy, with robotic-assisted surgery improving recovery. Radiation and systemic chemotherapy are options, sometimes combined. New immunotherapies and targeted treatments are emerging, with clinical trials offering additional options.
Prognosis and Prevention
Prognosis depends on tumor stage and grade. Early-stage cancers have better outcomes but frequently recur, requiring surveillance. Advanced cancers have poorer prognosis and need aggressive treatment. Smoking increases both incidence and severity.
Prevention focuses on smoking cessation, reducing occupational chemical exposure, and limiting environmental carcinogens like arsenic and disinfection byproducts in water. Protective measures and monitoring are essential to reduce incidence.
Epidemiology
Bladder cancer incidence is higher in men than women and varies by race, with whites at greater risk than African Americans, Hispanics, and Asian Americans. Age and smoking status strongly influence risk. Occupational exposures also contribute significantly, particularly in professions like painting.
Research and Future Directions
Research explores genetic and environmental interactions influencing bladder cancer risk. Genetic markers such as SNPs affecting immune response may interact with exposures like trihalomethanes to increase risk. Studies investigate environmental carcinogens, though evidence remains inconclusive for some agents.
Advances in biomarker and exposure assessment aim to improve risk stratification. Clinical trials continue to evaluate novel targeted therapies and minimally invasive surgical techniques to enhance treatment efficacy and reduce morbidity.
The content is provided by Harper Eastwood, Scopewires
