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Bladder Cancer

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Bladder Cancer: A Potential Serious Condition

Bladder cancer predominantly affects older adults, with a median age of diagnosis at 70 years. It is more common in men than women, with a ratio of 3:1, and its prevalence significantly exceeds its incidence. The disease is overwhelmingly composed of urothelial carcinoma (95%), with other histological types, such as squamous cell carcinoma (SCC) and adenocarcinoma, being rare.

Epidemiology

Bladder cancer predominantly affects older adults, with a median age of diagnosis at 70 years. It is more common in men than women, with a ratio of 3:1, and its prevalence significantly exceeds its incidence. The disease is overwhelmingly composed of urothelial carcinoma (95%), with other histological types, such as squamous cell carcinoma (SCC) and adenocarcinoma, being rare.

Risk Factors

Smoking

  • Smoking is a leading risk factor, increasing the hazard ratio by 2-4 times.
  • A dose-response relationship exists, particularly in individuals with over 40 pack-years of smoking history.
  • Risk reduction to baseline levels requires up to 20 years of cessation.

Occupational Exposures

  • High-risk industries include aluminium, dye, paint, petroleum, and rubber manufacturing.
  • Specific chemicals such as aromatic amines and aniline dyes are implicated.

Other Factors

  • Chronic cystitis from indwelling catheters or infections.
  • Prior pelvic radiation or cyclophosphamide therapy.
  • Genetic predispositions, including family history or conditions like Lynch syndrome.

Bladder cancer is a complex disease requiring multidisciplinary care. It is much easier to manage the condition, if detected early.

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Clinical Presentation

Common Symptoms

  • Visible, painless hematuria in 70-80% of cases.
  • Irritative voiding symptoms, such as dysuria and urgency, are more common in high-grade or invasive diseases.

Advanced Disease Symptoms

  • Palpable pelvic masses, flank pain, or systemic symptoms like weight loss.

Diagnosis

Bladder cancer diagnosis relies heavily on the following:

Cystoscopy

  • The gold standard for visualization of bladder lesions.
  • Allows for biopsy of any lesion if found.

Urine Cytology and Markers

  • Useful for detecting high-grade disease.

Imaging

  • CT and MRI help in staging and identifying muscle-invasive or metastatic disease.

Staging and Risk Stratification

Stages

  • Non-muscle-invasive bladder cancer (NMIBC): Includes Ta, T1, and carcinoma in situ (CIS).
  • Muscle-invasive bladder cancer (MIBC): Includes T2-T4 stages.

Risk Stratification for NMIBC

  • Based on tumour grade, stage, size, presence of CIS, and recurrence frequency.
  • Low-risk, intermediate-risk, and high-risk categories guide treatment decisions.

Treatment Modalities

  • Initial resection of the tumour is essential to confirm diagnosisto confirm diagnosis.
  • Intravesical therapies:
  • Chemotherapy: Mitomycin C within 24 hours post-TURBT reduces recurrence.
  • BCG Immunotherapy: Effective for high-risk NMIBC, reducing progression and recurrence rates.
  • Radical cystectomy with pelvic lymph node dissection is the standard.
  • Neoadjuvant chemotherapy improves survival by addressing micrometastases.
  • Select cases are treated with combined TURBT, chemotherapy, and radiotherapy.
  • Systemic chemotherapy with regimens like MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) or gemcitabine-cisplatin (GC).

Follow-Up and Prognosis

Surveillance

  • Regular cystoscopy and imaging based on risk stratification.
  • Low-risk patients: Annual follow-ups after initial 3- and 9-month checks.
  • High-risk patients: Frequent cystoscopies every 3-6 months for the first five years.

Prognosis

  • Early-stage NMIBC has excellent survival rates.
  • MIBC and metastatic disease require aggressive management and have poorer outcomes.

Bladder cancer is a complex disease requiring multidisciplinary care. It is much easier to manage the condition, if detected early.

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Make an Enquiry or Request a Consultation

Our friendly team is looking forward to serving you. For urgent enquiries and appointment requests, please call the clinic directly.

Dr Jay Lim is a urologist with a focus on providing personalised treatment plans specific to your unique urinary and reproductive health needs.

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