Diagnosis

Bladder cancer

Etiology

Cause

• Urothelial carcinoma (transitional cell carcinoma): 90% of the cases [3dh]

• Rarely squamous cell carcinoma and adenocarcinoma

• Very rare: Sarcoma of the bladder muscle, small cell carcinoma from the neuroendocrine cells

Pathophysiology [3dh]

1. Chronic inflammation (infection, toxic chemicals, carcinogenic molecules)

2. Increased cell turnover in the mucosa

3. Risk of DNA mutation in the critical areas

4. Genetic damage accumulates

5. Risk of malignant transformation

6. Tumor grade:

   • Cellular characteristics: low grade and high grade

   • Tumor invasiveness: Non-muscle-invasive and Muscle-invasive bladder cancer

Risk factors [3dh]

• Age

• Male

• Cigarette smoking: >10 pack-years

• Dye

• Toxic chemical exposures: Aromatic amine, ydrocarbon, arsenic, benzene products, formaldehyde, nitrosamine, petrochemicals, rubber

• Chronic inflammation

• Chronic indwelling catheter

• Recurrent urinary tract infection

• Schistosomiasis

• History of pelvic radiation

• Chemotherapy: cyclophosphamide, ifosfamide

• Metastasis (rare)

• Genetics: family history of bladder cancer, Lynch syndrome, Peutz-Jeghers syndrome, or Cowden syndrome

Epidemiology

Incidence per 100.000 [nea]

Approach

• Urine stix

• Urine cytology

• Intravenous pyelography

• Cystoscopy with tumor biopsy (photodynamic cystoscopy)

• CT urography

• MRI

• PET-CT

• Genetic test: FISH

Treatment

1. Low-grade, low-stage bladder cancer: [w4p]

   1. A single instillation of intravesical chemotherapy such as Bacillus Calmette-Guérin

   2. Cystoscopy controls

2. Muscle-invasive bladder cancer:

   1. Radical cystectomy and pelvic lymphadenectomy

      In comorbid patients: transurethral resection of bladder tumor (TUR-B)

   2. Followed by concurrent radiation therapy

   3. Then systemic chemotherapy

3. Metastatic Bladder Cancer: Systemic chemotherapy

4. Future treatment strategies:

   1. Gene therapy

   2. Immunotherapy

Differential diagnoses

Acute liver failure, Amyloidosis, Benign prostatic hyperplasia, Bladder cancer, Bladder exstrophy, Colovesical fistula, Diverticulitis, Hemangioma, Interstitial cystitis, Myoma uteri, Overactive bladder, Prostate cancer, Prostatitis, Renal cell carcinoma, Urinary tract infection, Urolithiasis