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| {{Infobox_Disease
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| | Name = Bladder cancer
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| | Image =
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| | Caption =
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| | DiseasesDB = 1427
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| | ICD10 = {{ICD10|C|67||c|64}}, {{ICD10|C|67|9|c|64}}
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| | ICD9 = {{ICD9|188}}, {{ICD9|188.9}}
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| | ICDO =
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| | OMIM = 109800
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| | MedlinePlus =
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{SCC}} | | {{Bladder cancer}} |
| ==Overview==
| | {{SCC}}; {{AE}} {{SC}} |
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| '''Bladder cancer''' refers to any of several types of malignant growths of the [[urinary bladder]]. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called urothelial cell or transitional cell carcinoma (UCC or TCC).
| | {{SK}} Carcinoma of bladder, cancer of bladder，carcinoma of the bladder, cancer of the bladder, malignant neoplasm of bladder, bladder neoplasm, bladder tumor, bladder tumour, malignant tumor of bladder, malignant tumour of bladder, carcinoma of urinary bladder, cancer of urinary bladder，carcinoma of the urinary bladder, cancer of the urinary bladder, malignant neoplasm of urinary bladder, urinary bladder neoplasm, urinary bladder tumor, urinary bladder tumour, malignant tumor of urinary bladder, malignant tumour of urinary bladder |
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| ==Signs and symptoms== | | ==[[Bladder cancer overview|Overview]]== |
| Bladder cancer characteristically causes blood in the urine; this may be visible to the naked eye (frank [[haematuria]]) or detectable only by microscope (microscopic hematuria). Other possible symptoms include [[Dysuria|pain during urination]], frequent urination ([[Pollakiuria]]) or feeling the need to urinate without results. These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including [[prostate]] infections and [[cystitis]]. | |
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| ==Causes== | | ==[[Bladder cancer historical perspective|Historical Perspective]]== |
| ===Risk factors===
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| Exposure to environmental carcinogens of various types is responsible for the development of most bladder cancers. Tobacco use (specifically cigarette smoking) is thought to cause 50% of bladder cancers discovered in male patients and 30% of those found in female patients. Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as [[benzidine]]. Occupations at risk are metal industry workers, rubber industry workers, workers in the textile industry and people who work in printing. Some studies also suggest that auto mechanics have an elevated risk of bladder cancer due to their frequent exposure to hydrocarbons and petroleum-based chemicals.<ref>[http://jnci.oxfordjournals.org/cgi/content/abstract/81/19/1480 Occupational Risks of Bladder Cancer in the United States: II. Nonwhite Men - Silverman et al. 81 (19): 1480 - JNCI Journal of the National Cancer Institute<!-- Bot generated title -->]</ref>
| | ==[[Bladder cancer classification|Classification]]== |
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| Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes. It has been proposed that hair dyes are a risk factor, and some have shown an odds ratio of 2.1 to 3.3 for risk of developing bladder cancer among women who use permanent hair dyes, while others have shown no correlation between the use of hair dyes and bladder cancer. Certain drugs such as [[cyclophosphamide]] and [[phenacetin]] are known to predispose to bladder TCC. Chronic bladder irritation (infection, bladder stones, catheters, [[bilharzia]]) predisposes to squamous cell carcinoma of the bladder. Approximately 20% of bladder cancers occur in patients without predisposing risk factors. Bladder cancer is not currently believed to be heritable (i.e., does not "run in families" as a consequence of a specific genetic abnormality).
| | ==[[Bladder cancer pathophysiology|Pathophysiology]]== |
| [This statement contradicts contents in the section that follows]
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| ===Genetics=== | | ==[[Bladder cancer causes|Causes]]== |
| Like virtually all cancers, bladder cancer development involves the acquisition of mutations in various [[oncogene]]s and [[tumor supressor gene]]s. Genes which may be altered in bladder cancer include [[H19 (gene)|H19]], [[FGFR3]], [[HRAS]], [[RB1]] and [[TP53]]. Several genes have been identified which play a role in regulating the cycle of cell division, preventing cells from dividing too rapidly or in an uncontrolled way. Alterations in these genes may help explain why some bladder cancers grow and spread more rapidly than others.
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| A family history of bladder cancer is also a risk factor for the disease. Many cancer experts assert that some people appear to inherit reduced ability to break down certain chemicals, which makes them more sensitive to the cancer-causing effects of tobacco smoke and certain industrial chemicals.
| | ==[[Bladder cancer differential diagnosis|Differentiating Bladder cancer from other Diseases]]== |
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| ==Diagnosis== | | ==[[Bladder cancer epidemiology and demographics|Epidemiology and Demographics]]== |
| The gold standard of diagnosing bladder cancer is urine cytology and transurethral (through the urethra) cystoscopy.
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| Urine cytology can be obtained in voided urine or at the time of the cystoscopy ("bladder washing"). Cytology is very specific (a positive result is highly indicative of bladder cancer) but suffers from low sensitivity (a negative result does not exclude the diagnosis of cancer). There are newer urine bound markers for the diagnosis of bladder cancer. These markers are more sensitive but not as specific as urine cytology. They are much more expensive as well.
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| Many patients with a history, signs, and symptoms suspicious for bladder cancer are referred to a [[urology|urologist]] or other physician trained in [[cystoscopy]], a procedure in which a flexible tube bearing a camera and various instruments is introduced into the bladder through the [[urethra]]. Suspicious lesions may be biopsied and sent for [[surgical pathology|pathologic analysis]].
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| ===Pathological Classification=== | | ==[[Bladder cancer risk factors|Risk Factors]]== |
| 90% of bladder cancer are [[Transitional cell carcinoma]]s (TCC) that arise from the inner lining of the bladder called the [[urothelium]]. The other 10% of tumours are [[squamous cell carcinoma]], [[adenocarcinoma]], [[sarcoma]], [[small cell carcinoma]] and secondary deposits from cancers elsewhere in the body.
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| TCCs are often multifocal, with 30-40% of patients having a more than one tumour at diagnosis. The pattern of growth of TCCs can be papillary, sessile (flat) or carcinoma-in-situ (CIS).
| | ==[[Bladder cancer screening|Screening]]== |
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| The 1973 [[WHO]] grading system for TCCs (papilloma, G1, G2 or G3) is most commonly used despite being superseded by the 2004 WHO <ref>Sauter G, Algaba F, Amin MB, Busch C, Cheville J,
| | ==[[Bladder cancer natural history|Natural History, Complications and Prognosis]]== |
| Gasser T, Grignon D, Hofstaedter F, Lopez-Beltran
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| A, Epstein JI. Noninvasive urothelial neoplasias:
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| WHO classification of noninvasive papillary
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| urothelial tumors. In [[World Health Organization]]
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| classification of tumors. Pathology and genetics of
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| tumors of the urinary system and male genital organs.
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| Eble JN, Epstein JI, Sesterhenn I (eds): Lyon,
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| IARCC Press, p. 110, 2004 </ref> grading (papillary [[neoplasm]] of low malignant potential (PNLMP), low grade and high grade papillary carcinoma.
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| CIS invariably consists of cytologically high grade tumour cells.
| | == Diagnosis == |
| | | [[Bladder cancer staging | Staging]] | [[Bladder cancer history and symptoms| History and Symptoms]] | [[Bladder cancer physical examination | Physical Examination]] | [[Bladder cancer laboratory tests | Laboratory Findings]] | [[Bladder cancer X Ray|X Ray]] | [[Bladder cancer CT|CT]] | [[Bladder cancer MRI|MRI]] | [[Bladder cancer ultrasound|Ultrasound]] | [[Bladder cancer other imaging findings|Other Imaging Findings]] | [[Bladder cancer other diagnostic studies|Other Diagnostic Studies]] | [[Bladder cancer biopsy|Biopsy]] |
| Bladder TCC is staged according to the 1997 [[TNM]] system: | |
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| *Ta Non-invasive papillary tumour
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| *T1 Invasive but not as far as the muscular bladder layer
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| *T2 Invasive into the muscular layer
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| *T3 Invasive beyond the muscle into the fat outside the bladder
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| *T4 Invasive into surrounding structures like the [[prostate]], [[uterus]] or pelvic wall
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| ===Staging===
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| The following stages are used to classify the location, size, and spread of the cancer, according to the TNM (tumor, lymph node, and metastasis) staging system:
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| *'''Stage 0''': Cancer cells are found only on the inner lining of the bladder.
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| *'''Stage I''': Cancer cells have proliferated to the layer beyond the inner lining of the urinary bladder but not to the muscles of the urinary bladder.
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| *'''Stage II''': Cancer cells have proliferated to the muscles in the bladder wall but not to the fatty tissue that surrounds the urinary bladder.
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| *'''Stage III''': Cancer cells have proliferated to the fatty tissue surrounding the urinary bladder and to the prostate gland, vagina, or uterus, but not to the lymph nodes or other organs.
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| *'''Stage IV''': Cancer cells have proliferated to the lymph nodes, pelvic or abdominal wall, and/or other organs.
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| *'''Recurrent''': Cancer has recurred in the urinary bladder or in another nearby organ after having been treated.<ref>{{cite news | first= | last= | coauthors= | title=The Gale Encyclopedia of Cancer: A guide to Cancer and its Treatments, Second Edition. Page no. 137 }}</ref>
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| ==Treatment== | | ==Treatment== |
| The treatment of bladder cancer depends on how deep the tumor invades into the bladder wall. Superficial tumors (those not entering the muscle layer) can be "shaved off" using an electrocautery device attached to a [[cystoscope]]. [[Immunotherapy]] in the form of [[Bacillus Calmette-Guérin|BCG]] instillation is also used to treat and prevent the recurrence of superficial tumors.<ref>{{cite journal | volume=353 | pages=1689–94 | year=1999 | issue=9165 |
| | [[Bladder cancer medical therapy|Medical Therapy]] | [[Bladder cancer surgery|Surgery]] | [[Bladder cancer primary prevention|Primary prevention]] | [[Bladder cancer secondary prevention|Secondary Prevention]] | [[Bladder cancer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Bladder cancer future or investigational therapies|Future or Investigational Therapies]] |
| title=BCG immunotherapy of bladder cancer: 20 years on. | url=http://linkinghub.elsevier.com/retrieve/pii/S0140673698074224}}</ref>
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| BCG immunotherapy is effective in up to 2/3 of the cases at this stage. Instillations of [[chemotherapy]] into the bladder can also be used to treat superficial disease.
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| Untreated, superficial tumors may gradually begin to infiltrate the muscular wall of the bladder. Tumors that infiltrate the bladder require more radical surgery where part or all of the bladder is removed (a [[cystectomy]]) and the urinary stream is diverted. In some cases, skilled surgeons can create a substitute bladder (a neobladder) from a segment of intestinal tissue, but this largely depends upon patient preference, age of patient, [[renal function]], and the site of the disease.
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| A combination of [[radiation]] and [[chemotherapy]] can also be used to treat invasive disease. It has not yet been determined how the effectiveness of this form of treatment compares to that of radical ablative surgery.
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| There is weak observational evidence from one very small study (84) to suggest that the concurrent use of [[statin]]s is associated with failure of BCG immunotherapy.<ref>{{cite journal | volume=355 | pages=2705–7 | year=2006 | issue=25 |
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| title=Use of statins and outcome of BCG treatment for bladder cancer | url=http://content.nejm.org/cgi/content/full/355/25/2705 }}</ref>
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| ==Epidemiology==
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| In the United States, bladder cancer is the fourth most common type of cancer in men and the ninth most common cancer in women. More than 47,000 men and 16,000 women are diagnosed with bladder cancer each year. One reason for its higher incidence in men is that the [[androgen receptor]], which is much more active in men than in women, plays a major part in the development of the cancer.<ref>{{cite news | first= | last= | coauthors= | title=Scientists Find One Reason Why Bladder Cancer Hits More Men | date=April 20 2007 | publisher=University of Rochester Medical Center | url =http://www.urmc.rochester.edu/pr/news/story.cfm?id=1436 | work = | pages = | is who want kill others accessdate = 2007-04-20 | language = }}</ref>
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| ==References==
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| {{reflist|2}}
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| ==External links==
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| * [http://www.cancer.gov/cancertopics/types/bladder Cancer.gov: bladder cancer]
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| * [http://www.nlm.nih.gov/medlineplus/bladdercancer.html Medlineplus: Bladder Cancer]
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| * [http://ccrod.cancer.gov/confluence/display/~rohitp/Ro.Blog Retired Cancer Researchers Blog]
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| {{Tumors}}
| | ==Case Studies== |
| {{SIB}}
| | [[Bladder cancer case study one|Case #1]] |
| [[bs:Rak mokraćnog mjehura]]
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| [[da:Blærecancer]]
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| [[de:Blasenkrebs]]
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| [[es:Cáncer de vejiga]]
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| [[fr:Cancer de la vessie]]
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| [[hr:Rak mokraćnog mjehura]]
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| [[ja:膀胱癌]]
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| [[no:Urinveiskreft]]
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| [[pl:Rak pęcherza moczowego]]
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| [[pt:Câncer de bexiga]]
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| [[ru:Рак мочевого пузыря]]
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| [[fi:Virtsarakon syöpä]]
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| [[sv:Urinvägscancer]]
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| [[zh:膀胱癌]] | |
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| {{WH}} | | {{WH}} |
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| [[Category:Types of cancer]] | | [[Category:Types of cancer]] |
| [[Category:Urology]] | | [[Category:Urology]] |
| [[Category:Mature chapter]] | | [[Category:Up-To-Date]] |
| | [[Category:Oncology]] |
| | [[Category:Medicine]] |
| | [[Category:Nephrology]] |
| | [[Category:Surgery]] |