Bladder Cancer
Benign or malignant tumors may develop on the bladder wall surface or grow within the wall itself and quickly invade underlying muscles. About 90% of bladder cancers are transitional cell carcinomas, arising from the transitional epithelium of mucous membranes. They may result from malignant transformation of benign papillomas. Less common bladder tumors include adenocarcinomas and squamous cell carcinomas.
Bladder tumors are most prevalent in people older than age 50, are more common in males than in females, and occur more often in densely populated industrial areas. (See Bladder cancer in females, page 94.) Bladder cancer is the fourth most common cause of cancer death in males older than age 75.
Despite treatment, the patient with superficial disease has up to an 80% chance for recurrence. Only about 10% of superficial bladder cancers develop into invasive disease; in invasive disease, however, the patient’s chances for metastasis increase up to 90%. With treatment, about 50% of patients with invasive cancer experience complete remission; 20% have partial remission.
Causes
Certain substances, such as tobacco, 2-naphthylamine, and nitrates, may predispose a person to transitional cell tumors. This places certain industrial workers (including rubber workers, weavers, aniline dye workers, hairdressers, petroleum workers, spray painters, and leather finishers) at high risk for developing these tumors. The latency period between exposure to the carcinogen and development of signs and symptoms of a tumor is about 18 years.
Squamous cell carcinoma of the bladder is common in geographic areas where schistosomiasis is endemic, such as Egypt. Furthermore, it’s associated with chronic bladder irritation and infection in people with renal calculi, indwelling urinary catheters, chemical cystitis that is caused by cyclophosphamide, and pelvic irradiation.
Complications
If bladder cancer progresses, complications include bone metastasis and problems resulting from tumor invasion of contiguous viscera.
Assessment
The patient typically reports gross, painless, intermittent hematuria (often with clots). He may complain of suprapubic
pain after voiding (which suggests invasive lesions). Other signs and symptoms include bladder irritability, urinary frequency, nocturia, and dribbling. If the patient reports flank pain, he may have an obstructed ureter and subsequent hydronephrosis.
pain after voiding (which suggests invasive lesions). Other signs and symptoms include bladder irritability, urinary frequency, nocturia, and dribbling. If the patient reports flank pain, he may have an obstructed ureter and subsequent hydronephrosis.
Gender differencesBLADDER CANCER IN FEMALES
Bladder cancer is considered to be primarily a disease of older, white males. It’s considered relatively rare in females; however, the prevalence of bladder cancer in females is comparable to the number of females with cervical and ovarian cancer. A greater percentage of females are diagnosed with bladder cancer at a more advanced stage than males, which may contribute to the higher mortality in females with this condition. Contributing factors include higher incidence of nontransitional cell cancer histologies in females, such as adenocarcinoma, small cell carcinoma, and squamous cell carcinoma; the relative thinness of an elderly female’s bladder, which may permit more rapid extravesical spread; and the older median age at presentation in females. Higher incidence of bladder cancer was found in females who smoke, use hair dye, or drink tap water containing nitrates.
Diagnostic tests
To confirm a diagnosis of bladder cancer, the patient typically undergoes cystoscopy and biopsy. If the test results show cancer cells, further studies will determine the cancer stage and treatment.
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