Bladder Cancer

Epidemiology

Risk Factors

  • Benzidine Exposure: aniline dye intermediate
  • Genetic Mutations
    • HRAS
    • KRAS2
    • RB1
    • FGFR3
  • Low Daily Oral Water Intake: risk of bladder cancer might be related to carcinogens which are excreted in urine being in concentrated contact with the bladder
  • Occupational Risk
    • Bus Drivers: may be related to long urine dwell times in bladder
    • Rubber Workers: due to aniline exposure (in rubber) (see Aniline, [[Aniline]])
    • Mechanics
    • Leather Workers: due to aniline dye exposure
    • Blacksmiths
    • Machine Setters
    • Hairdressers: due to exposure to hair dyes
    • Printing Workers: due to aniline exposure
    • Textile Workers: due to aniline dye exposure (most commonly indigo, which is used in blue jeans)
  • Tobacco Abuse (see Tobacco, [[Tobacco]])
    • 2-Naphthylamine is found in tobacco smoke and may play a role
    • Linear relationship between tobacco use and risk of bladder cancer
    • Tobacco use is associated with >50% of bladder cancer cases in men and 33% of cases in women
    • Cessation of tobacco use decreases the risk of bladder cancer
    • Second-hand smoke exposure is not a risk factor

Pathology of Bladder Cancer

  • Urothelial Cell Carcinoma (Transitional Cell Carcinoma) (see Urothelial Cell Carcinoma, [[Urothelial Cell Carcinoma]]): 90% of bladder cancer cases are due to urothelial cell carcinoma
  • Squamous Cell Carcinoma
  • Adenocarcinoma
  • Sarcoma
  • Small Cell Carcinoma

Diagnosis

  • Cystoscopy
    • Hexvix/Cysview Guided Fluorescence: may increase detection rates
  • Pelvic CT: may be used for staging

Clinical Manifestations

Renal Manifestations

  • Microscopic or Gross (Macroscopic) Hematuria (see Hematuria, [[Hematuria]]): present in 80-90% of cases
  • Dysuria (see Dysuria, [[Dysuria]])
  • Frequent Urination
  • Inability to Urinate
  • Palpable Bladder Mass: uncommon

Other Manifestations

Metastases to Lungs

  • Epidemiology
    • Lung is the only site of metastasis in only 9% of cases
    • There are case reports of metastases to lungs even with superficial Tumors, with no prior evidence of muscle invasion [MEDLINE]
  • Clinical

Treatment

Surgery

  • Transurethral Resection: for early stage tumors
  • Cystectomy: for more advanced disease

Chemotherapy

  • Bacillus Calmette-Guerin (see Bacillus Calmette-Guerin, [[Bacillus Calmette-Guerin]]): intravesical
  • Docetaxel (Taxotere) (see Docetaxel, [[Docetaxel]]): indicated for transitional cell pathology
  • xxxx

Treatment of Lung Metastases

  • Surgical Resection: may considered for isolated lung metastases

References

  • Cavitary Pulmonary Metastases in Transitional Cell Carcinoma of Urinary Bladder. AJR 154:493-494, March 1990
  • Occupational bladder cancer in textile dyeing and printing workers: six cases and their significance for screening programs. J Occup Med. 1990 Sep;32(9):887-90 [MEDLINE]
  • Cystic Pulmonary Metastasis of Bladder Cancer: Report of Two Cases. Turkish Respiratory Journal, December 2002, Vol.3, No.3
  • Superficial Bladder Cancer Metastatic to the Lungs: Two Case Reports and Review of the Literature. Urology 2009; 73: 210 [MEDLINE]
  • Surgery for Isolated Lung Metastasis in Two Patients with Bladder Cancer. Urology 2005; 66: 881
  • Urothelial bladder cancer with cavitary lung metastases. Can Respir J Vol 18 No 3 May/June 2011
  • Metastasis from transitional cell carcinoma of urinary bladder as cystic pulmonary lesion. J Thorac Dis 2011;3:71-73