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Introduction

Bladder cancer arises from the urothelial lining of the bladder. It is the 10th most common cancer worldwide, with a high recurrence rate. The majority of cases are urothelial carcinoma (transitional cell carcinoma, TCC), which can be either non-invasive (superficial) or muscle-invasive.

Bladder cancer is more common in men and is strongly associated with smoking and occupational exposure to chemicals.

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Types of Bladder Cancer

1. Urothelial Carcinoma (90–95%)

  • Non-Muscle Invasive Bladder Cancer (NMIBC): Limited to the bladder lining (Ta, T1, CIS).
  • Muscle-Invasive Bladder Cancer (MIBC): Invades the bladder wall, requiring aggressive treatment.

2. Rare Types of Bladder Cancer (5–10%)

  • Squamous Cell Carcinoma (SCC): Linked to chronic irritation (e.g., schistosomiasis).
  • Adenocarcinoma: Rare, aggressive.
  • Small Cell Carcinoma: Neuroendocrine origin, highly aggressive.

Risk Factors

  • Smoking: Strongest risk factor, causing ~50% of cases.
  • Chemical exposure: Aromatic amines, dyes, rubber industry.
  • Chronic bladder irritation: Infections, stones, catheters, schistosomiasis.
  • Prior radiation therapy: Especially to the pelvis.

Signs and Symptoms

  • Painless hematuria: Blood in urine, most common symptom.
  • Frequent urination, urgency, burning sensation.
  • Pelvic pain, back pain: Seen in advanced disease.

Diagnosis

1. Urine-Based Tests

2. Imaging Tests

3. Cystoscopy with Biopsy (Definitive Diagnosis)

Treatment Options

1. Non-Muscle Invasive Bladder Cancer (NMIBC)

  • TURBT (First-line treatment)
  • Intravesical Therapy

2. Muscle-Invasive Bladder Cancer (MIBC)

  • Radical Cystectomy (Gold standard for MIBC)
  • Neoadjuvant Chemotherapy
  • Bladder Preservation (Trimodal Therapy: TURBT + Chemoradiation)

3. Metastatic Bladder Cancer

  • Systemic Chemotherapy
  • Immunotherapy
  • Targeted Therapy

Prognosis and Follow-Up

  • NMIBC (5-year survival ~80–90%)
  • MIBC (5-year survival ~50% with treatment)
  • Metastatic Bladder Cancer (depends on response to treatment)

Follow-up

  • Regular cystoscopy for NMIBC
  • CT scans for MIBC & metastatic cases

Frequently Asked Questions (FAQs)


A: Yes, through urine tests and cystoscopy, especially in high-risk individuals (smokers, chemical workers).
A: No, but painless hematuria should never be ignored. It can also be due to infections or stones.
A: Yes, if detected early. NMIBC has a high recurrence rate but is manageable with treatment. MIBC requires aggressive treatment for cure.
A: Yes. Regular follow-ups with cystoscopy are crucial.
A: Quit smoking, avoid chemical exposure, drink plenty of fluids, and manage urinary infections promptly.

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